[Competitive hormonally active adrenal tumours (aldosteroma and pheochromocytoma)].

The development of two hormonally active tumours in one adrenal gland is a very rare event. Four cases with this condition are reported. Clinical, instrumental, and morphological characteristics of aldosteromas and pheochromocytomas are presented. Peculiarities of anesthesiological management of such patients are discussed. Classification of concomitant adrenal pathologies and proposals on its modification are presented. Relevant literature publications are reviewed and analysed.

[Role of immunohistochemical study of extracellular matrix components in the estimation of the malignant potential of adrenal pheochromocytomas].

The changes occurring in the extracellular matrix structure and composition greatly affect cell behavior. The present investigation has indicated that active tenascin-C expression is observed in malignant pheochromocytomas, suggesting the altered composition of the extracellular matrix, there is also activation of metalloproteinase-9 and cyclooxygenase-2, which play an important role in many biological processes, including the invasion and metastatic spread of tumor cells, as well as in neoangiogenesis. Benign pheochromocytomas display a slight immunopositive staining of these antigens.

[Adrenal gland surgery].

The authors of the article analyze more than 30-year experience of surgical treatment of adrenal gland diseases, offering a detailed description of clinical and morphological features of the main nosological forms such as Itsenko-Cushing disease and syndrome, primary hyperaldosteronism, pheochromocytoma, incidentaloma, and malignant adrenal tumors. The paper contains basic diagnostic criteria, indications to operative treatment, and extents of surgery for each of the diseases considered, as well as comparative analysis of peculiarities of conventional ("open"), and endoscopic adrenal gland surgeries. The article demonstrates significance of various immunohistochemical markers in differentiation between malignant and benign adrenal tumors.

[Morphology of the kidneys in arterial hypertension of adrenal genesis (according to biopsy findings)]. / Morfologiia pochek pri arterial'noi gipertenzii nadpochechnikovogo geneza (po dannym biopsii)

67 renal biopsies obtained in the course of adrenalectomy from patients with primary hyperaldosteronism, hypercorticism and pheochromocytoma were studied. Sclerotic affection of the arterioles and renal interstitium were found in long lasting adrenal arterial hypertension. This may cause residual postoperative hypertension. Endocrine nephropathy in primary hyperaldosteronism due to hypopotassemia and alcalosis manifests with vacuolar distrophy and atrophy of the epithelium, dilatation of tubular lumen, intratubular calcinosis and tubulointerstitial nephritis. Primary hyperaldosteronism was characterized by hypoplasia of the juxtaglomerular apparatus (JGA) but in massive spironolacton therapy signs of enhanced renin-secreting function of the glomerular efferent arteriola may be observed. In hypercorticism pyelonephritis is rather frequent. In patients with pheochromocytoma hypercatecholaminemia may result in JGA activation this being particularly evident in renal artery stenosis. Recurrent hypertension after pheochromocytoma removal in the absence of renal pathology may indicate recurrent tumor or missed second tumor.

[Methods of silver impregnation in morphological diagnosis of gastric syphilis]. / Metody serebreniia v morfologicheskoi diagnostike sifilisa zheludka.

Comparative assessment of methods of silver impregnation for pathohistological identification of Treponema pallidum in gastric syphilis was performed. Levaditi impregnation is preferable in cases of gastrectomy. Silver impregnation in histological slides is performed for studying endoscopic biopsies in view of their small size as well as for retrospective analysis when paraffin blocks only are available. Steiner's method in modification with the use of microwave stove allows better identification of Treponema pallidum than impregnation by Vartin-Starri. Helicobacter pylori may also be identified by silver impregnation. Association of syphilitic and Helicobacter infections deteriorates inflammatory and destructive lesions in the stomach.

[Mesenchymal tumor of the small pelvis with hypoglycemic syndrome]. / Mezenkhimal'naia opukhol' malogo taza s sindromom gipoglikemii.

In spite of a large size, mesenchymal tumor of the small pelvis was not diagnosed clinically, and hypoglycemia was considered as a manifestation of hyperinsulinism. The tumor was identified as mesenchymal, most likely fibrosarcoma, immunohistochemically. The use of antibodies against insulin, glucagon and somatostatin showed the disturbance in the balance of cells in the hyperplastic islands of the pancreas. Multifocal hyperplasia of the islands is considered as a compensatory adaptive reaction to paraneoplastic extrapancreatic hypoglycemia.

[A retrospective clinico-morphologic study of insulinoma]. / Retrospektivnoe kliniko-morfologicheskoe issledovanie insulinom.

Surgical material from 51 patients operated on for insulinoma is studied. Three histological variants of insulinoma are distinguished: adenoma-like, insular-ductal and carcinoid-like. The structure of Langerhans islands outside the tumour is described and the diagnostic criteria of insuloma-microadenoma are presented. Multiple nests of the endocrine cells are regarded either as a manifestation of the multifocal island pathology or as a marker of non-diagnosed insuloma. There is a need of distinguishing between the terms related to the nosology and histogenesis of endocrine pancreatic tumours.

[Adrenocortical tumors: mitotic index and nuclear size as criteria for differential diagnosis and prognosis]. / Adrenokortikal'nye opukholi: mitoticheskii indeks i velichina iader kak kriterii differentsial'noi diagnostiki i prognoza.

A comparative study of the mitotic index (MI) and karyometric indices in 15 adrenocortical tumors with clinical syndrome of hypercorticism allowed to distinguish between adenomas and carcinomas. Carcinomas with hypercorticoidism symptoms have common features with inactive carcinomas but are different by lower expression of malignancy criteria (polymorphism, atypia, necrotic foci, capsule and vessel invasion), higher MI, increasing deficiency of cell division and larger nuclear size of tumor cells. Such tumors may be included into the prognostic group of risk.

[Adrenocortical tumors with neuroendocrine differentiation]. / Adrenokortikal'nye opukholi s neiroéndokrinnoi differentsirovkoi.

18 adrenocortical tumours and 5 pheochromocytomas were studied immunohistochemically. Expression of synaptophysin and chromogranin A was found in cells of cortical adenomas, "frontier" neoplasms and in 20-75% of carcinoma cells, this ultramicroscopically was confirmed by observation of typical neuroendocrine granules. Some groups of cells of cortico-medullary tumours also expressed proteins of neural differentiation (protein S-100).

[Adrenal ACE and type II glucocorticoid receptors in primary hyperaldosteronism]. / Nadpochechnikovyi angiotenzinprevrashchaiushchii ferment i gliukokortikoidnye retseptory II tipa pri pervichnom giperal'dosteronizme.

Adrenal tissue from 6 patients with primary hyperaldosteronism has been examined for the presence of angiotensin-converting enzyme (ACE). Its activity and amount of glucocorticoid receptors of type II (GR-II) were measured. ACE and GR-II were detected in adrenal tissue. GR-II induce ACE activity in interaction with plasma hydrocortisone. The glucocorticoid-receptor mechanism is an essential element in regulation of ACE activity determining a vasopressor effect. Disclosed is one of the aspects of tissue renin-angiotensin system function in primary hyperaldosteronism.

[Pathogenesis of arterial hypertension in the Itsenko-Cushing syndrome]. / K patogenezu arterial'noi gipertenzii pri sindrome Itsenko-Kushinga.

The search and measurements of the activity of angiotensin-converting enzyme (ACE) and glucocorticoid receptors of type II (GR II) were made in the adrenals of 19 patients with Icenko-Cushing syndrome (ICS). ACE and GR II were detected in the tissues of the adrenal cortex and cortisol-producing tumors. It is suggested that glucocorticoids may induce ACE activity and in this way potentiate synthesis of angiotensin II. The effect is mediated by GR II. Activation of such tissue components of the renin-angiotensin system contributes much to the mechanism underlying arterial hypertension.

[Metastases from renal tumor to adrenals]. / Metastazy opukholi pochki v nadpochechnikakh.

The aim of the study was assessment of diagnosis and surgical treatment of adrenal metastases (AM) of renal carcinoma (RC). 10 cases of RC AM have been analysed. Bilateral metastases were diagnosed in 2 patients, ipsilateral in 5 patients, contralateral in 3. Three patients had synchronous metastases, seven had metachronous ones. AM were detected 8 months to 14 years after after operation on the kidney. Non-invasive dynamic control over the retroperitoneal space after nephrectomy for RC using advanced visual methods (ultrasonography, x-ray and resonance magnetic CT) not only detects AM but also determines metastatic genesis of the tumor. Thus, significant verification of RC AM, especially of metachronous origin, requires the study of the findings obtained at clinical, laboratory, ultrasonic, radiation examinations as well as comparison of histological structure of the removed kidney tumor and the adrenal. Early diagnosis and removal of a solitary adrenal metastasis of RC provides prolongation of the patient's life and survival of patients with RC late stages.

[A method for the surgical treatment of patients with chronic postoperative osteomyelitis of the sternum]. / Metod khirurgicheskogo metoda lecheniia bol'nykh s khronicheskim posleoperatsionnym osteomielitom grudiny.

The authors share their experiences with diagnosing and surgical treatment of chronic postoperative osteomyelitis of sternum developed in 36 patients after operations on the heart, lungs and organs of mediastinum. The purulent process can be liquidated in all the patients due to performing saving resection of the sternum and plasty of the bone defect with local tissues, application of a gauze-cotton roll pressing the subcutaneous fat into the bone defects formed after treatment of the affected portions of the sternum, administration of antibiotics according to sensitivity of the microflora.