[Enucleation of pancreatic tumors: a multiple-center study]. / Enukleatsiya opukholei podzheludochnoi zhelezy (mnogotsentrovoe issledovanie).

OBJECTIVE: To evaluate the immediate results of enucleation of pancreatic neuroendocrine tumors (pNETs). MATERIAL AND METHODS: The results of enucleation of pancreatic neuroendocrine tumors (pNETs) were analyzed in 95 patients between 2016 and 2021. Functioning tumors (mean size 16.8 mm) were found in 70 patients, non-functioning (mean size 25 mm) - in 25 patients. Intraparenchymal tumors were found in 48 people, extraorganic lesion - in 47 patients. RESULTS: There were 262 patients with pNETs who underwent various surgeries between 2016 and 2021. Various resections were performed in 167 (63.8%) cases, enucleations - in 95 (36.2%) patients. Traditional surgical approach was used in 65 patients. Pancreatic fistula occurred in 21 patients (type B - 17, type C - 4), while arrosive bleeding occurred in 6 patients with unfavorable outcomes in 2 cases. Minimally invasive surgeries were performed in 30 patients. Eight patients with intraparenchymal tumors required conversion to open surgery. Type B pancreatic fistula occurred in 5 patients that led to arrosive bleeding in 2 cases (hemostasis was provided by endovascular method). Comparison of intraparenchymal and extraorgan tumors regarding the incidence of pancreatic fistula revealed odds ratio 5.26 (95% CI 1.5355; 18.0323, p=0.0041). Postoperative mortality was 2.1%. CONCLUSION: Enucleation is advisable for highly differentiated pancreatic neuroendocrine tumors up to 2 cm. Minimally invasive enucleation is indicated for extraorgan tumors. Intraparenchymal tumors significantly increase the risk of postoperative complications.

Diagnostic Capabilities of Islet Autoantibodies in Children with New-Onset Type 1 Diabetes Mellitus and Healthy Siblings.

The aim of the study is to determine the diagnostic utility of several islet autoantibodies and their combinations in order to identify individuals susceptible to type 1 diabetes mellitus (T1DM) among healthy siblings in the pediatric population within the scope of the development of a screening program. MATERIALS AND METHODS: A total of 424 children were evaluated, 260 children with new-onset T1DM and 164 healthy children with brothers and/or sisters with T1DM.Blood tests for a complex of autoantibodies to insulin (IAA), tyrosine phosphatase (IA-2A), zinc transporter 8 (ZnT8A), pancreatic ß-cells (ICA), and glutamate decarboxylase (GADA) were conducted in all the subjects with the enzyme immunoassay method. RESULTS: It was found that the diagnostic utility of individual autoantibodies is not equal and varies with age. The optimal age groups for the immunological control of the risks of developing type 1 diabetes in healthy siblings were determined. The highest risks were noted with the combination of GADA, ZnT8A, and IA-2A. CONCLUSION: Islet autoantibodies may serve as prognostic markers of the risk of developing type 1 diabetes in healthy siblings.

Multiphoton Microscopy and Mass Spectrometry for Revealing Metabolic Heterogeneity of Hepatocytes in vivo.

The aim of the investigation was to study the possibility of revealing the heterogeneity of normal liver hepatocytes in terms of metabolic status using the modern methods of multiphoton microscopy and mass spectrometry. Materials and Methods: Heterogeneity of hepatocytes in terms of total metabolic activity was assessed using multiphoton microscopy based on the autofluorescence intensity of intracellular cofactors NAD(P)H and FAD. Hepatocyte heterogeneity in terms of intensity of intracellular metabolic processes was determined using the fluorescence lifetime imaging (FLIM) method based on the data about fluorescence lifetime contributions of various forms of NAD(P)H. The method of time-of-flight secondary ion mass spectrometry (TоF-SIMS) was used to study the lipid and amino acid composition of hepatocytes. Results: It has been revealed using multiphoton microscopy that hepatocytes are heterogeneous in terms of general metabolic activity. Using FLIM, it was established that the heterogeneity degree was high in terms of intensity of oxidative phosphorylation, glycolysis, and synthetic processes (lipogenesis, nucleic acid synthesis, and the pentose phosphate pathway). The TоF-SIMS method revealed the presence of hepatocyte heterogeneity in terms of amino acid and lipid composition, which points to various intensities of synthetic processes in individual hepatocytes. Moreover, differences in the content of PO3 ions were revealed. The results of ToF-SIMS study correlate with the data obtained by multiphoton microscopy and FLIM, confirming the revealed heterogeneity of hepatocytes in terms of general metabolic activity and intensity of intercellular metabolic processes. Conclusion: The latest methods of fluorescence bioimaging and mass spectrometry proved to be effective in revealing hepatocyte heterogeneity in terms of metabolic status. The presence of heterogeneity should be taken into account in studying the liver tissue under various conditions with the application of fluorescence bioimaging methods.

[The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy]. / Rossiiskii konsensus po diagnostike i lecheniiu khronicheskogo pankreatita: zamestitel'naia fermentnaia terapiia.

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children's Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

[Long-term treatment results and quality of life of the patients, operated on the reason of chronic pancreatitis, complicated by the obstructive jaundice].

Methods of surgical treatment of the patients, operated on the reason of chronic pancreatitis, complicated by the obstructive jaundice, were comparatively analyzed. 25 patients received pancreatoduodenal resection, 19 patients had the Bern variant of Beger operation. The quality of life was assessed with the use of MOS-SF-36. The duodenum preserving resection of the head of the pancreas showed better long-term results then pancreatoduodenal resection. Those patients, who received biliodigestive anastomosis as the basic operation, showed no good results at all.

[Ultrasound study of the liver and kidneys after different types of resection].

The ultrasound pattern of hepatic and renal changes after different types of resection is depicted. Ultrasound studies were performed in 335 patients operated on for focal hepatic masses and in 72 patients operated on for focal renal masses. The authors identified 3 patient groups after hepatic resection (segment-oriented liver resection (99 patients), portal hemihepatectomy (n=163), and extended hemihepatectomy (n=73)) and 3 patient groups after renal resection (planar (n = 83), wedge (n = 104), and frontal (n = 66)). It has been established that the number and location of hepatic veins in the liver stump, which the authors have designated as a hepatic vein rule, are of basic value in defining the type of hepatic resection. To determine the type of renal resection, it is essential to assess the shape of the organ and the area of its resection. The found echosemiotic patterns allow the type of performed resection of parenchymatous organs to be correctly determined in the majority of cases.

[Surgical treatment of colorectal cancer liver metastases with microwave thermoablation].

Domestic device for destruction of tumors by microwave power was designed. Initial series of laboratory experiments were performed with microwave liver ablation. Primary series of patients with colorectal cancer metastases to the liver demonstrate positive results. Short-term exposure, programmable shapes and sizes of ablative zones are the distinctive advantages of microwave thermoablation (MTA). 329 patients underwent liver resections during 2005-2010 years.108 patients had colorectal cancer metastases to the liver. 52 (48,14%) patients had bilobar liver lesions. Among them 11 patients underwent liver resection combined with MTA of contralateral liver lesions. Reliable differences in survival rates among patients with monolobar and bilobar metastatic lesions were not observed. Median of survival rate amounted 22.8 months in patients operated for metastatic colorectal cancer. Variants of surgical treatment are proposed.

[Optical coherence tomography in surgical treatment of esophageal cancer].

The authors present an analysis of possibilities of optical coherence tomography in preoperative determination of the proximal interface of the tumor. Under investigation there were 24 patients (14 of them with squamous cell carcinoma and 10 with adenocarcinoma), with localization of the process not more than 5 cm the from z-line.

[Results of combined surgeries for cancer of the colon complicated with stomach and duodenal fistulas].

Positive results of combined surgeries in locally advanced cancer of the colon complicated with gastric fistula (3 patients) and duodenal fistula (1 patient) are presented. Effective treatment of these patients requires complex examination, good preoperative preparation, perfect anesthetic management, adequate operation and intensive postoperative (including antibacterial) therapy.

[Surgical treatment of patients with generalized atherosclerosis of the aorta and its branches]. / Khirurgicheskoe lechenie bolnykh s rasprostranënnym aterosklerozom aorty i eë vetvei.

The article analyses experience accumulated since September 1988 by the Department of Vascular Surgery based on Nizhny Novgorod Regional Clinical Hospital. The Department is equipped with apparatuses by means of which patients with generalized atherosclerotic lesions of the aorta and its branches can be examined to a full measure. The authors performed 287 operations on 205 patients with 3.9% mortality. The tactics of surgical treatment of patients with various atherosclerotic lesions of the aorta and its branches are analysed. It is concluded that multistage correction of the blood flow is most optimal in such patients.

[Surgical tactics in combined occlusive diseases of the brachiocephalic arteries and terminal segment of the aorta]. / Khirurgicheskaia taktika pri sochetannykh okkliuziruiushchikh porazheniiakh brakhiotsefal'nykh arterii i terminal'nogo otdela aorty.

An associated pathology of brachycephalic arteries and aortofemoral segment was found in 37.7% of cases. Operations on brachycephalic arteries (1st stage of the treatment) were performed on 29 patients, on the aorto-femoral segment (2nd stage)--on 26 patients. An interval between the stages was from 2-3 weeks up to 1-1.5 months and depended on the degree of occlusive injury of the aorto-femoral segment. All the patients showed clinical improvement confirmed by control rheovasography.