[Classification of pancreatic exocrine tumours].

Current international histologic classification of exocrine pancreatic tumours is presented. Macro- and microscopic characteristics of benign and malignant tumors are described. The role of immunohistochemistry in differential diagnosis is shown.

[Adult hepatoblastoma].

A rare case of hepatoblastoma is reported in a female of 47 years of age with literature review of these tumors in the adults. Microscopically the tumor was represented by the cells of embryonal and fetal types. Immunohistochemically expression of low-molecular cytokeratins as well as that of S-100 protein and hepatocyte antigen was observed.

[Electron-radioautographic study of parasympathetic paragangliomas (chemodectomas) of the neck]. / élektronno-radiograficheskoeissledovanie parasimpaticheskikh paragangliom (khemodectom) shei.

Chemodectomas, after the surgery, were studied in 7 patients. Morphologically their malignancy is proven on the basis of pronounced cell polymorphism, atypia, invasion of tumour cells through the vessel wall into their lumen. Besides rare mitoses, proliferative (DNA synthesis) and protein synthetic (RNA synthesis) activity in clear and dark cells was not observed in the presence of intensive biosynthetic processes in the stroma cells.

[Ultrastructural analysis of Pseudomonas aeruginosa invasion into the blood capillaries of the subcutaneous fat]. / Ul'trastrukturnyi analiz invazii sinegnoinoi palochki v krovenosnye kapilliary podkozhnoi kletchatki.

Wound wall soft tissues from 14 male rats were studied electron-microscopically 5 hours after subcutaneous implantation of a gauze piece with 3 X 10(10) organisms of Ps. aeruginosa on it. In a special series of experiments done on 75 rats, 78% of the animals have demonstrated a generalized pseudomonal infection, i. e. sepsis. The bacterial invasion into the blood stream occurred on the microcirculatory level due to inadequacy of the phagocytic barrier caused by bacterial damage of micro and macrophages. Vascular wall component destruction and capillary haemostasis (stasis, thrombosis) appeared to predispose the microbial invasion into the vascular lumen. The bacteria entered the circulation by the microembolic mechanism.

[Histological variants of parasympathetic paragangliomas (chemodectomas) of the neck and morphological variants of their malignancy]. / Gistologicheskie varianty parasimpaticheskikh paragangliom (khemodektom) shei i morfologicheskie kriterii ikh zlokachestvennosti.

Histotopograms of 28 chemodectomas have been studied. Principal microscopic features of malignancy are as follows: structural atypia (complete in solid or fibrous variants) or partial (alveolar chemodectoma) loss of alveolarity as the most important sign of organotypia; another sign of malignancy is cell cataplasia (cell and nuclear polymorphism, change in nuclear-cytoplasmic relationship in the direction of its increase, nuclear hyperchromatism, appearance of large ungly hyperploid nuclei, mitotic activity of tumour cells in one case. Incomplete angiogenesis characteristic for malignant tumours was also detected. Invasive growth in the majority of chemodectomas in the form of partial growth through the walls of great vessels and ubiquitous growth through the walls of small vessels were present in most chemodectomas. Thus, there is a basis to claim that the chemodectomas studied are malignant tumours although they are characterized by a slow (years) growth and slow progression.

[Polyposis of the gallbladder]. / Polipoz zhelchnogo puzyria.

A rare observation of the gall bladder polyposis in a woman of 56 with clinical symptoms of chronic cholecystitis is described. In this case, polyposis of the gall bladder was combined with extensive extra- and intrahepatic lithiasis. The observation is compared with reports in the literature.

[The morphological changes in liver hemangiomas and in organ tissue after endovascular occlusion of branches of the hepatic artery based on the results of a study of surgical material]. / Morfologicheskie izmeneniia v gemangiomakh pecheni i v tkani organov posle éndovaskuliarnoi okkliuzii vetvei pechenochnoi arterii po rezul'tatam issledovaniia operatsionnogo materiala.

30 haemangiomas and surrounding liver tissues removed surgically are studied histologically. 11 patients underwent endovascular occlusion of the hepatic artery peripheral branches at various intervals before the operations. The lack of reaction of the vascular wall to the X-ray noncontrast emboli and minimal reaction to the X-ray contrast emboli were found. The persistence of the vascular lumen occlusion is proved. The degree of the haemangioma blood filling is reducing, the cavernae recede and the tumour sclerosis occurs after the endovascular occlusion. Aseptic necrosis in the haemangioma and small necrosis of liver tissue are possible.

[The morphological characteristics of the fibromyalgia syndrome]. / Morfologicheskaia kharakteristika sindroma fibromialgii.

A histological and ultrastructural study of dense foci characteristics for soft tissues in fibromyalgia syndrome revealed that they consist of rough fibrillar connective tissue frequently hyalinized. Vascularization occurred at the periphery of these foci only where thin nervous fibrils and sometimes small paraganglia were seen. Severe degenerative changes of the collagen fibers, marked decrease and degeneration of fibroblasts were found electron microscopically. Signs of inflammation were absent.

[The causative agent of wound infection and sepsis in burn patients]. / Vozbuditel' ranevoi infektsii i sepsisa u obozhzhennykh.

The content of antibodies to the autostrains of bacteria isolated from the wound and blood of burn patients was studied. Antibodies were found not to all species and strains isolated from the wound, but only to 1 or 2 of them. Usually Staphylococcus aureus and Pseudomonas were detected. The appearance or sharp rise of the titer of antibodies even to one of all strains contaminating the wound was observed in all examined burn patients, including those having septic complications, i.e. all these patients retained their capacity of antibody formation. The causative agent of wound infection and sepsis, determined by a high titer of antibodies to it, was seldom detected in the blood. This was due to the fact that bacteria were agglutinated by antibodies or retained in tissues on the level of the histo-hematic barrier. In cases of the development of septic endocarditis the inhibiting role of antibodies was not manifested, and the causative agent of this infection was often detected in the blood.

[Diagnosis and treatment of leiomyosarcomas of inferior vena cava]. / Diagnostika i lechenie leiomiosarkom nizhnei poloi veny.

3 clinical cases and literature data, illustrate effective diagnostic and surgical policy in patients with uncommon type of tumor. Two patients were previously operated in other clinics, but the operations were diagnostic because the tumors were estimated as being inoperable. In all 3 patients radical operations were carried out with resection of infrarenal segment of inferior cava vein without its prosthetic reconstruction. In did not result in substantial blood flow disturbances, because before the operation it was known about the presence of well functioning collaterals. The significance of ultrasound examination, especially duplex scanning, computer tomography and angiography (cavagraphy) is emphasized. Favourable results of treatment, especially conclusion of the tumor resectability are more common in specialized institutions.

[Surgical treatment of chronic pancreatitis in combination with duodenal ulcer disease]. / Khirurgicheskoe lechenie khronicheskogo pankreatita v sochetanii s iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Results of two surgeries--total and subtotal resection of pancreatic head in combination with selective proximal vagotomy (SPV)--performed for chronic pancreatitis and duodenal ulcer disease (DUD) are presented. In one case surgery was supplemented with circular resection of the duodenum and fundoplication. Reconstructive stage of both surgeries included creation of pacreato- and biliodigestive anastomosis on Roux intestinal loop. Choledochojejunoanastomosis was created on the same loop of the small intestine either "end-to-side" with supraduodenal part of common bile duct or "side-to-side" with its pancreatic part. The former surgery was finished with duodenoduodenoanastomosis "end-to-end" for recovery of duodenal passage. This surgery was characterized by complete removal of pancreatic head. The latter surgery corresponded to Beger's operation. There were no complications in the nearest postoperative period. Long-term results were favorable and followed up during 17.5 and 7 months, respectively. This experience testifies that resection of pancreatic head with SPV may be considered as alternative to pancreatoduodenal resection in surgical treatment of patients with chronic pancreatitis.

[Portal embolization (an experimental-morphological study)]. / Portal'naia émbolizatsiia (éksperimental'no-morfologicheskoe issledovanie).

Results of experimental-morphological study of influence of unilobar portal embolization by biologic occlusive material RABROM on the liver of 6 laboratory animals are presented. It is shown that portal venous embolization leads to focal necrosis of parenchyma of embolized hepatic lobe, it atrophy and formation of portal cirrhosis. In non-embolized hepatic lobe the distinct signs of increased regeneration and hypertrophy of hepatocytes were revealed. RABROM didn't lead to damage and inflammatory changes of vascular wall that testifies to it biologic inertia. It is recommended to use the method of portal venous embolization for preparation of patients with low functional hepatic reserve for extensive resections.

[Thermal trauma in a combination with respiratory tract burn]. / Termicheskaia travma v sochetanii s ozhogom dykhatel'nykh putei.

The detection rate of microbial contamination of burn wounds after flame burn was studied in dynamics to 3 weeks in 56 patients forming 2 similar groups: basic--with thermo-inhalation lesions (TIL) and control--without TIL. General area of skin burns in all the patients was less than 50% of the body surface, on average it was 40%, the area of deep burns was 23%. Cytological and bacteriologic methods were used for study microphlora in the sputum and in bronchoalveolar lavage. There were 186 cases of wound microbial contamination (gram-negative microorganisms--64.4% cases, gram-positive--34%, pathogenic fungi--1.6%). In 80% cases the microphlora of the wounds was polymicrobial, in 47% cases the microphlora were detected on the second week. Microphlora was detected 2 times more often in the basic group than in the control, corresponded to skin burn area; the greatest exceeding of critical level of wound contamination was revealed on the first 2 weeks. In TIL besides wound contamination, polymicrobial microphlora revealed in tracheobronchial tree, presented on the first 2 weeks with association of gram-positive and gram-negative microorganisms, combining on week 3 with fungal phlora. Early leukocytosis, not reducing during first 3 weeks of the study, due to intoxication by burn products, occurred in TIL. Early lymphopenia in TIL was the sign of resistant immunodeficiency.

[Recurrent profuse hemorrhage in gastric angiodysplasia]. / Retsidiviruiushchie profuznye krovotecheniia pri angiodisplazii zheludka.

Dieulafoy's disease--i.e. arteriovenous malformation--is a rare cause of gastric bleedings, which makes up 1.5-3% of all sources of hemorrhage. All the armory of diagnostic modalities may require to reveal arteriovenous malformations. Angiography of the stomach appeared to be the most informative method for diagnosis of this disease in 2 patients. Radical treatment of patients with Dieulafoy's disease implies resection of the proximal part of the stomach or gastrectomy. Endoscopic hemostasis (with the use of coagulation and injections of sclerogenous preparations around the diseased area) results in temporary effect.