[Endovascular treatment of delayed arterial bleeding after pancreatic surgery: single-center experience]. / Rezul'taty rentgenendovaskulyarnogo lecheniya pozdnego arterial'nogo krovotecheniya posle operatsii na podzheludochnoi zheleze. Opyt odnogo tsentra.

OBJECTIVE: To evaluate technical aspects and clinical results of transcatheter arterial embolization (TAE) for delayed postoperative arterial bleeding after pancreatic surgery. MATERIAL AND METHODS: There were 821 pancreatectomies between 2012 and 2020. Delayed bleeding occurred in 106 (12.9%) patients; 74 patients were included in the study. Previous pancreatic head resection was carried out in 75.7% of cases, pancreatic body resection - in 17.6% of cases, pancreatic tail resection - in 6.8% of patients. Primary endpoint was technical success of TAE, secondary endpoints - complications after TAE, as well as recurrent bleeding after embolization. RESULTS: Angiography of celiac-mesenteric arterial system was performed in 74 patients (91 procedures). The most common sources of bleeding were gastroduodenal and superior mesenteric arteries (35.7%), jejunal arteries (13.1%), common hepatic artery (11.9%). Combination of embolization agents was applied for TAE (metal coils and non-calibrated PVA particles, 48.6%). In 11 (14.9%) patients, we applied stent-grafts. Technical success rate was 100%. Recurrent bleeding occurred in 13 (17.6%) patients. In-hospital mortality was 12.2% (n=9). CONCLUSION: TAE is an effective treatment procedure in patients with arrosive bleeding. This method is characterized by high technical efficiency and low in-hospital mortality, but it does not affect recurrence of bleeding.

[Pancreatic proinsulinoma]. / Proinsulinoma podzheludochnoi zhelezy.

OBJECTIVE: To report own experience in the treatment of patients with proinsulinoma. MATERIAL AND METHODS: There were 10 patients with increased proinsulin production and normal insulin level since 2017. Most of them were young women. RESULTS: Fasting hypoglycemia in all patients was severe (up to 0.7 mmol/l). Clinical picture consisted of typical symptoms similar to those in insulinoma. The main difference in the course of proinsulinoma was the absence of weight gain in 7 patients and rapid weight loss (from 210 to 90 kg within 9 months) in 1 patient. All patients with proinsulinoma underwent surgery. In most cases, minimally aggressive surgery was performed. CONCLUSION: Proinsulinoma is an extremely rare endocrine-active neuroendocrine pancreatic tumor. Differential features of proinsulinoma are the absence of weight gain and normal insulin levels in the presence of hypoglycemia. Surgery is the only radical method of treatment.

[Circular tracheal resection for acquired tracheal stenosis: evaluation of early and long-term outcomes]. / Tsirkuliarnaia rezektsiia pri rubtsovom stenoze trakhei: analiz neposredstvennykh i otdalennykh rezul'tatov.

AIM: To present single-center experience and results of surgical treatment of acquired tracheal stenosis. MATERIAL AND METHODS: There were 99 patients with acquired tracheal stenosis for the period from January 2008 to December 2017. Median age was 39 (28; 55) years (range 19-79 years), male/female ratio - 64/35. There were 59 patients with tracheostomy-related stenosis, 31 - post-intubation injury, 6 - posttraumatic stenosis, malignant and idiopathic stenosis was observed in 2 and 1 patients, respectively. Single-stage circular tracheal resection or staged surgical approach were preferred depending on localization and severity of stenosis, respiratory function at admission, severity of concomitant diseases and possibility of prolonged head adduction, presence of tracheostomy and cervical tissues inflammation, functional state of laryngeal structures. RESULTS: Single-stage circular tracheal resection was applied in 44 (44.4 %) out of 99 cases. In 55 (55.6%) patients staged approach was preferred: Montgomery T-tube placement followed by tracheoplasty after 6-12 months - 27 patients; tracheoplasty on prefabricated endotracheal stent - 8 patients; staged endotracheal treatment (including Dumon prosthesis deployment) - 12 patients. In 11 cases circular resection was done as a final stage of treatment. There was no in-hospital mortality after circular tracheal resection. Morbidity included anastomotic dehiscence - 2 (3.6%), recurrent stenosis in 6 months after surgery - 1 (1.8%), granulation tissue growth followed by stenosis - 4 (7.3%), wound infection - 3 (5.5%) cases), postoperative pneumonia - 2 (3.6%) patients, respectively. CONCLUSION: Tracheal resection is preferred for tracheal stenosis management. Alternative techniques are life-saving procedures, but could potentially extent the length of stenosis and delay recovery of the patient.

[Surgical treatment of retroperitoneal masses]. / Khirurgicheskoe lechenie neorgannykh zabriushinnykh opukholei.

AIM: To improve the results of treatment of patients with retroperitoneal tumors. MATERIAL AND METHODS: The study included 83 patients with retroperitoneal tumors including 57 cases of benign tumors and 26 patients with malignancies. Laparotomy (Lt), robot-assisted (RA) and laparoscopic (Ls) techniques were used in 35, 34 and 14 patients respectively. Median tumor sizes in the largest dimension were 102 mm, 75 mm and 81.5 mm in Lt, RA and Ls groups respectively. RESULTS: Average time of surgery was 112.5 minutes in Lt-group, 140 min in RA group and 125 minutes in Ls group. Median blood loss was 125 ml, 50 ml and 50 ml in the same groups respectively. Conversion was performed in 1 patient during RA-surgery and in 7 patients during laparoscopy. Postoperative complications occurred in 6 patients after laparotomy and in 5 patients after RA-intervention. There were no deaths. CONCLUSION: Comprehensive evaluation of different surgical methods is necessary to achieve successful treatment of retroperitoneal tumors. Conventional approach is indicated for tumors over 10 cm while minimally invasive techniques are justified for tumors less than 10 cm. RA-interventions facilitates surgery for tumors located in difficult areas and small anatomical spaces as well as for neoplasms adjacent to great vessels.

[Problems of the diagnostics of perivascular epithelial cell tumors].

Perivascular epithelioid cell tumors is a group of rare tumors composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. There are no specific imaging sighs. In most cases, the final diagnosis is possible only after the immunihistochemical study. These tumors are extremely rare. We present imaging findings of two cases of perivascular epithelioid cell tumors of the liver.