[Laparoscopic ultrasound guided partial nephrectomy].

INTRODUCTION: The choice of method of surgical treatment for endophytic kidney tumors depends on the precise definition of the location and size, the extent of invasion into adjacent tissues and the type of vascularization. Intraoperative ultrasound (IOUS) in combination with 3D-CT allow to receive this information. The aim of this study was to compare the laparoscopic-assisted extracorporeal partial nephrectomy and laparoscopic partial nephrectomy with IOUS and visualization in Full HD, 3D Full HD and 4K modes. MATERIALS AND METHODS: A total of 77 patients aged 43-75 years with endophytic renal tumors were included in the study. They were undergone either extracorporeal partial nephrectomy or laparoscopic partial nephrectomy with IOUS. We compared the rate of positive surgical margins, early postoperative bleeding, de novo renal failure or aggravation of preexisting renal failure and stricture of vesico-ureteric anastomosis. RESULTS: The rate of early postoperative bleeding, chronic kidney failure and pathologically-proven positive surgical margin in patients who underwent extracorporeal partial nephrectomy followed by kidney autotransplantation was 23.1%, 13.4% and 13.4%, respectively. After laparoscopic partial nephrectomy these values were 12%, 16.7% and 8.3%, respectively. The best outcomes were achieved in patients who underwent laparoscopic partial nephrectomy with IOUS and with a use of visualization in Full HD, 3D Full HD and 4K modes.

[Left-sided renal cell cacrinoma with vena cava inferior thrombus: totally laparoscopic removal].

A surgical treatment of patients with tumor thrombus in the inferior vena cava (IVC) of levels II-III, originating from the left renal vein involves performing thrombectomy, radical nephrectomy and lymph nodes dissection. In most cases it requires major open surgery which leads to complications in 38% of patients and perioperative mortality of 4-10%. In recent years, the laparoscopic radical nephrectomy with thrombectomy have been gradually introduced. However, there are anecdotal reports about performing of such interventions in case of left-sided renal tumor with thrombus in the IVC. A description of technique and own experience of performing laparoscopic radical nephrectomy with thrombectomy from the IVC in 3 patients with tumor thrombus of levels II-III, originating from left kidney are presented. In one case distant metastases were detected preoperatively and in another patient an involvement of tail of the pancreas by the tumor was diagnosed. There was no conversion to open surgery. The maximum tumor size ranged from 5 to 16 cm. The length of tumor thrombus in the IVC was 2.4-7 cm and estimated blood loss was 300-2500 ml. In one case a blood transfusion was required postoperatively. The follow-up period was 4-26 months. One patient died from progression of the disease after 5 months, two other patients are alive without any signs of relapse. The initial experience of laparoscopic radical nephrectomy with thrombectomy from IVC in patients with left-sided renal cell cancer suggests that this technique is reproducible and relatively safe with respecting of basic principles of oncology and vascular surgery. The surgery is not associated with major perioperative complications, significant blood loss and is accompanied by a rather favorable postoperative period. An accumulation of a larger number of cases is needed to assess the oncological results of this technique.

Identification and localization of differences between Escherichia coli and Salmonella typhimurium genomes by suppressive subtractive hybridization.

The availability of bacterial genome sequences raises an important new problem - how can one move from completely sequenced microorganisms as a reference to the hundreds and thousands of other strains or isolates of the same or related species that will not be sequenced in the near future? An efficient way to approach this task is the comparison of genomes by subtractive hybridization. Recently we developed a sensitive and reproducible subtraction procedure for comparison of bacterial genomes, based on the method of suppression subtractive hybridization (SSH). In this work we demonstrate the applicability of subtractive hybridization to the comparison of the related but markedly divergent bacterial species Escherichia coli and Salmonella typhimurium. Clone libraries representing sequence differences were obtained and, in the case of completely sequenced E. coli genome, the differences were directly placed in the genome map. About 60% of the differential clones identified by SSH were present in one of the genomes under comparison and absent from the other. Additional differences in most cases represent sequences that have diverged considerably in the course of evolution. Such an approach to comparative bacterial genomics can be applied both to studies of interspecies evolution - to elucidate the "strategies" that enable different genomes to fit their ecological niches - and to development of diagnostic probes for the rapid identification of pathogenic bacterial species.