[Complex surgical treatment of recurrent post-injection abscess in a patient with systemic autoimmune disease]. / Kompleksnoe khirurgicheskoe lechenie retsidiviruyushchego postin"ektsionnogo abstsessa na fone sistemnogo autoimmunnogo zabolevaniya.

The authors present complex surgical treatment of a patient with rheumatoid arthritis and persistent wound in the right gluteal region after previous surgical treatment of post-injection abscess. According to these data, active surgical treatment of wounds and purulent-necrotic lesions of any etiology and localization, augmented by modern agents for local and systemic therapy (including phage therapy) provide favorable functional and cosmetic results even in patients with systemic autoimmune diseases receiving glucocorticosteroids. It is important to assess the wound process considering not only clinical data, but also objective information of qualitative and quantitative microbiological and cytological examinations.

[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.

[Sepsis biomarkers dynamics as an indicator of intensive care effectiveness]. / Dinamika biomarkerov sepsisa kak pokazatel' éffektivnosti intensivnoi terapii.

AIM: To evaluate dynamics of presepsin, procalcitonin and C-reactive protein in survived and dead patients with sepsis. MATERIAL AND METHODS: There were 41 patients with diagnosis of 'sepsis' ('Sepsis-3' concept) who were divided into 2 groups: survived patients with sepsis (21 people) - group 1, dead patients with sepsis (20 people) - group 2. All patients underwent generally accepted intensive therapy for sepsis. Besides conventional laboratory and instrumental examination, dynamics of presepsin, procalcitonin and C-reactive protein was assessed. RESULTS: Mean level of presepsin was 1718.00 and 3266.50 pg/ml in groups 1 and group 2, respectively. Half of the values was within (Me (25; 75) 1021.00-3231.00 pg/ml and 1618.50-7469.00 pg/ml in both groups, respectively. Mean level of procalcitonin was 0.995 and 4.465 ng/ml, respectively. Median (25; 75) was 0.49-4.44 ng/ml and 1,625-19.30 ng/ml, respectively. Mean level of C-reactive protein was 95.5 and 215.0 mg/L, respectively, median (25; 75) - 64.00-155.00 mg/L and 155.00-264.00 mg/L, respectively. Significant differences were determined for all variables (p-value 0.000008, 0.000242, 0.0000001 for presepsin, procalcitonin and C-reactive protein, respectively). CONCLUSION: The levels of C-reactive protein, procalcitonin and presepsin were significantly different in patients with sepsis followed by favorable and unfavorable clinical outcome. Unfavorable outcome was associated with increased levels of all biomarkers. Comprehensive assessment of all biological markers of sepsis is useful to assess an effectiveness of intensive therapy and to predict clinical outcome.

[Mucinous cystic liver tumors: diagnosis and surgical treatment]. / Mutsinoznye kistoznye opukholi pecheni: diagnostika i khirurgicheskoe lechenie.

AIM: To optimize diagnostics and treatment of cystic liver tumors. MATERIAL AND METHODS: The analysis included outcomes of 46 patients with liver cystic tumors. RESULTS AND DISCUSSION: The use of abdominal Doppler-sonography (37 patients), abdominal contrast-enhanced CT (44 patients) and MRI of abdominal cavity with MR-cholangiography (24 patients) defined radiological semiotics of cystic liver diseases. The most important features of cystic tumors are intraluminal septums with blood flow (82% of patients), solid component (6.8%), daughterly cysts (11.3%), as well as biliary hypertension (39.2% of patients). Research of oncomarkers (CEA, SA 19-9, AFP) in 40 patients showed increased level of SA 19-9 only in case of cystadenocarcinoma and intraductal papillary mucinous neoplasm of biliary type. Benign and malignant cystic tumors had increased contents of oncomarkers in all cases. Surgical treatment was used in 42 patients. Extended liver resections were performed in 10 (23.8%) patients, atypical and anatomical resections (removal of less than 3 segments) - in 31 (73.8%) patients. In one case we applied cryoablation of CA in segment I of the liver in view of invasion into the wall of inferior vena cava and hepatoduodenal ligament. In 2 cases surgery was carried out laparoscopically. Also robot-assisted technique was used in 3 patients. Immunohistochemical study was performed in 22 (44.8%) patients. The diagnosis of CAC and biliary type of IPMN was confirmed in case of high expression of CK7, SK19, MUC1, S100p, SDH2, p53 antibodies. Cystadenomas were associated with moderate expression of ER, PR and p53 antibodies by stroma and CK7, SK19, CDX2, MUC1, S100p antibodies by epithelium. CONCLUSION: There are considerable difficulties of differential diagnosis of liver cystic tumors. Therefore, the use of single algorithm of diagnostics and treatment is necessary to confirm accurately the diagnosis at the perioperative stage. Cystic tumor is more likely to be assumed in women with solitary cyst in segment IV of liver. If the diagnosis is suspected or confirmed anatomical liver resection with complete tumor removal is necessary to prevent the recurrence.

[Carbohydrate metabolism abnormalities in patients with cancer of major duodenal papilla before and after pancreaticoduodenal resections].

56 Patients with cancer of major duodenal papilla were examined before and after pylorus-saving pancreaticoduodenal resection. Carbohydrate metabolism was estimated before and after the operation, impact of the operation on diabetes mellitus progression was detected. If there were no carbohydrate metabolism abnormalities in 75% before the operation, then there were 55% of such patients after the operation. After the pylorus-saving pancreaticoduodenal resection the impaired glucose tolerance was detected in 4 (7%) of patients whose carbohydrate metabolism had corresponded to norms before the operation. 7 (13%) of 17 (31%) patients had diabetes mellitus of mild severity after the pylorus-saving pancreaticoduodenal resection, the rest 10 (18%) had diabetes mellitus of moderate severity. In 7 (13%) patients after the pylorus-saving pancreaticoduodenal resection the diabetes mellitus of moderate severity was detected for the first time, at that in 4 patients diabetes mellitus of mild severity was detected, and in 3 patients--diabetes mellitus of moderate severity (everyone received insulin therapy in the long-term postoperative period) was detected. Checking protocol of the patients' carbohydrate metabolism in the perioperative period was described in detail. The possibility of prognostication of carbohydrate metabolism abnormalities in the long-term postoperative period by indications of carbohydrate metabolism before the operation and in early postoperative period was studied. Middle blood glucose level in early postoperative period is an informative indication for prognostication of carbohydrate metabolism state in the long-term postoperative period. An algorithm of patients' examination with cancer of major duodenal papilla before the operation and after it was offered; also checking protocol of carbohydrate metabolism indices and correction of the detected abnormalities in the early postoperative period were offered.

[Carbohydrate metabolism after pancreatoduodenal resections in patients with chronic pancreatitis].

The carbohydrate metabolism was analyzed in 70 patients with the complicated chronic pancreatitis before and after pylorus-preserving pancreatoduodenal resection (PPDR). Patients were aged 42±1,15 years, of them 64 were men and 6 - women. Bodymass index was 2,2±0,54kg/m2. Patients were divided in groups according to pre- and postoperative glucose metabolism disorders to define the diabetes morbidity by chronic pancreatitis and the influence of surgery on the first. According to the preoperative data, diabetes mellitus of mild severity had 9 of 70 operated patients, 18 patients had medium diabetes. After the operation only one patient demonstrated the aggravation of diabetes. However, the onset of diabetes mellitus was registered in 8 patients postoperatively. The increased glucose blood level in early postoperative period proved to have a high prognostic significance. Therefore, all patients of that category must be strongly recommended to be under the endocrinologist's observation after hospital discharge. That measure would provide a timely diagnose and treatment of the diabetes mellitus. All patients with chronic pancreatitis should be thoroughly investigated concerning glucose metabolism disorders before the operation.

[Hyperhomocysteinemia and plasma acute-phase proteins in patients with type 2 diabetes mellitus and severe course of atherosclerosis after vascular operations].

Interdependence between the level of homocysteine and acute-phase proteins was assessed in patients presenting with a severe course of atherosclerosis. We examined a total of 67 patients aged 62.3 +/- 1.03 years. Of these, 34 patients had type 2 diabetes mellitus and 35 were non-diabetic. The diabetic patients were found to suffer a severe course of the disease, with 65.6% having a decompensated form. We carried out a comparative analysis of the level of homocysteine, C-reactive protein, and that of fibrinogen. It was noted that diabetic patients significantly more often showed high levels of blood-plasma total homocysteine, C-reactive protein, and that of fibrinogen as compared to nondiabetic patients. Hyperhomocysteinemia appeared to correlate with elevated levels of C-reactive protein (r = 0.37, p = 0.04) and that of fibrinogen (r = 0.36, p = 0.04) at HbA1c > or = 7%. The obtained findings strongly suggest interrelationship of high levels of blood-plasma homocysteine and an elevation in acute-phase proteins in a decompensated form of diabetes mellitus and the presence of sluggish chronic inflammation in all patients, either with or without diabetes mellitus. Inclusion of homocysteine measuring and a highly sensitive method for determining C-reactive protein into the standard of examining patients with atherosclerosis improves diagnosis of the pathological condition, while timely correction of the impairments revealed promotes a decrease in the risk of the development of complications.

[Treatment of coagulation disoreders in patients with diabetes mellitus type II].

Efficacy of out-hospital treatment of coagulation disorders in patients with diabetes mellitus type II (DMII) in comparison with non-diabetic patients after aortic-femoral reconstruction was studied. Long-term results were obtained within 65,1±3,95 months after surgery. Data of 67 patients were obtained, of them 32 had severe DMII, 35 patients had no diabetic disorders. 94% of patients had various hypercoagulation disorders and thrombophilia stage I-II. Desagregant therapy was noneffective in 70,1% of patients. Patients with atherosclerosis after reconstructive vascular surgery showed disorders of both thrombocytic and plasma links of coagulation, which requires combined (anticoagulant and desagregant) therapy. Patients with DMII require also blood glucose and HbA1c control postoperatively.

[RNA tumor marker levels in blood of patients with malignant tumors of the gastrointestinal tract].

In order to develop a diagnostic panel, mRNA levels of tumor marker genes have been evaluated in capillary blood of patients with various malignant tumors of the gastrointestinal tract (GIT) by means of the method of reverse transcription combined with real-time PCR with detection of reaction products using TaqMan probes. Use of small volumes of capillary blood did not decrease sensitivity of this method. RNA expression of telomerase (mhTERT), alpha-fetoprotein (mAFP), carcinoembryonic antigen (mCEA) and cytokeratin-20 (mCK-20) was higher in most patients with tumors. Blood of donors or non-oncological patients contained much lower (trace) amounts of the RNA markers. The RNA markers are characterized by reasonably high specificity and sensitivity acceptable for diagnostic application. The mhTERT marker was the most universal one and exhibited the highest specificity and sensitivity. Combined determination of several RNA markers increased sensitivity of this method. It is concluded that determination of RNA markers in small volumes of capillary blood may be used for screening, primary diagnostics, and postoperative monitoring.

[Carbohydrate metabolism disturbances after pancreatoduodenal resection in patients with cancer of the head of pancreas].

Carbohydrate metabolism was explored in 52 patients with cancer of the head of pancreas before and after pylorus-preserving pancreatoduodenal resection. Glycemia, insulin dosage, glucosuria and acetonuria were assessed retrospectively to reveal correlation with postoperative carbohydrate metabolism disturbances. Preoperatively 46.2% of patients had no metabolic problems, whereas postoperatively only 38.5% of patients showed normal sugar metabolism. 9 (17.3%) patients developed disturbed glucose tolerance, 5 (9.6%) patients developed mild diabetes mellitus and 18 (34.6%) patients had diabetes of medium severity. Combination of first diagnosed diabetes mellitus, progressive weight loss and abdominal pain proved to be the negative prognostic set of symptoms and should urge on pancreatic tumor search. Glucose level in early postoperative period is a valuable prognostic criteria for the development of carbohydrate metabolism disturbances in long-term postoperative period.

[Assessment of the level of homocysteine and the state of haemostasis in patients with and without type 2 diabetes mellitus in remote terms after reconstructive operations on the aorto-iliac segment].

The authors carried out a comparative analysis of the level of homocysteine and the state of haemostasis in patients with and without type 2 diabetes mellitus in the remote terms after endured reconstructive operations on the aorto-iliac segment. They examined a total of eighty-eight patients who had endured reconstructive operations on the aorto-iliac segment at various terms. Of these, forty-two patients were found to have a severe course of type 2 diabetes mellitus (59.9% with decompensation) and forty-six subjects without diabetes constituted the group of comparison. The average age of the patients amounted to 61.9 +/- 1.25 years, with all being smokers. The following parameters were assessed: patency of the bypasses and major arteries of the lower limbs (LL), homocysteine (Hey), fibrinolytic activity, fibrinogen, activated partial thromboplastin time (aPTT), factor XIII, thrombin time, prothrombin index, activity of antithrombin III (AIII), platelet aggregation with ADP, and glycosylated haemoglobin (Hb Aic).

[Analysis of quality of ambulatory follow-up of patients with type 2 diabetes mellitus after reconstructive operations on the aortoiliac segment].

The article is dedicated to assessment of quality of ambulatory management of patients suffering from type 2 diabetes mellitus in remote terms following reconstructive operations on the aortoiliac segment. The aspects investigated included the frequency of the of patients' visiting the district polyclinic, as well as frequency and quality of planned examinations and conservative treatment. Presented herein are the results of questioning and comprehensive examination of fifty-six patients suffering from type 2 diabetes mellitus (mean age 62.3 +/- 1. 7years) performed averagely 61.9 +/- 2.1 months after surgical treatment. Fifty percent of these patients appeared to have prior to the operation had critical ischaemia of the lower extremities. By the time of the check up examination, 62.5% of these preserved stage 1 or 2A ischaemia and 37.5% had stage 2B ischaemia, which on the whole was indicative of a long-term positive outcome of surgical interventions in this severely ill cohort of patients. During this time period, in 23 (41.1%) patients with baseline critical ischaemia it turned out possible to avoid limb amputation, and 62.5% were found to have considerably increased the distance of pain-free walking (stage 1 or 2A). Together with it, the obtained findings suggested virtually total lack of adequate angiological care for the postoperative patients at the ambulatory-polyclinic level. First of all, there are neither correctly organized dispensary follow up of patients nor continuity between the clinical hospital and the polyclinic. Analysing the check-up clinical evidence showed that 83.9% of patients required correction of blood glucose level, 96.4% that of lipid profile, and 73.2% that of the haemocoagulation system. Twenty-five (44.6%) patients required stagewise reconstructions due to an atherosclerotic lesion of the previously intact arteries of the lower limbs (21), prosthesis-leg thrombosis (1) and anastomotic restenosis (3). Hence, the clinical effect of a clinical intervention in diabetic patients is apparently evident. Correct and adequate organization of therapeutic and preventive care at the ambulatory and polyclinic level may substantially improve the remote results of vascular operations in this cohort of patients.

[The chronic pancreatitis caused glucose metabolism disturbances before and after distal pancreatic resections].

Glucose metabolism is evaluated before and after the operation in 51 patients (41--men, 10--women), operated on account of the complicated chronic pancreatitis. The distal pancreatic resection (50% of the gland) was performed in all cases. The middle age of the patients is 41.2+/-7.9. Body mass index (BMI) was 23.7+/-3.4 kg/m2. After distal pancreatic resection 33.33% of patients with chronic pancreatitis didn't have glucose metabolism disturbances. In 27.45% of patients diabetes mellitus was diagnosed for the first time after the operation. At the same time, in 5.8% of cases the worsening from the light to the moderate form of diabetes mellitus was observed. As far as blood glucose level (glycemic control) doesn't have any prognostic value in predicting diabetes mellitus in early postoperative period, it is necessary to recommend regular supervision by the endocrinologist to the patient after discharge. All patients with chronic pancreatitis should be carefully investigated so as to detect glycaemic disorders. It is recommended to determine fasting blood glucose level, glycemia throughout the day, glycated hemoglobin, 24 hours' glucosuria. It is also essential to perform an oral glucose tolerance test (OGTT).

[Intraoperative administration of low-molecular-weight heparins in reconstructive vascular operations].

The article deals with analysing the outcomes of administering low-molecular-weight heparins (LMWH) by the example of nadroparin ("Fraxiparin") during the intraoperative period in patients diagnosed with atherosclerotic lesions of femoropoplietal-crural segment of the lower-limb arteries as compared with non-fractionated heparin (NFH). Studied were the alterations in the parameters of the plasmatic and thrombocytic links of haemostasis on the background of administering various molecular-weight fractions of heparin. A conclusion was drawn on advantageous use of LMWH in the cohort of the patients involved. Also presented herein is an analysis of the literature data concerning appropriate usage of LMWH during the intraoperative period.

[Study of gene expression of cytokines and apoptotic factors in blood and tissues from patients with surgery infection by the method of real-time polymerase chain reaction].

The expression of cytokines and markers of apoptosis was studied in the whole blood of 10 volunteers by means of reverse transcription method combined with real-time PCR. These factors were also measured in the whole blood, in inflammation nodus tissues and in amputation level nodal tissues taken from 17 patients with local surgical infection. No expression of examined factors in whole blood of volunteers has been observed. However, genes of cytokines and apoptotic markers were expressed in different levels in lymphocytes of whole blood for the case of patients with local surgery infection. This expression was lower in tissues from amputation level and was almost absent in tissues from inflammation nodus, except of the gene, encoding caspase-8. These results suggest that number of pro- and antiinflammating cytokines and apoptotic factors are expressed in peripheral blood and tissue lymphocytes at the formation of System Inflammation Response Syndrom.

[Neutrophilic respiratory response in surgical infection and an association with plasma membranous synthesis of ATP]. / Respiratornyi otvet neitrofilov pri khirurgicheskoi infektsii i sviaz' s plazmamembrannym sintezom ATP.

Early studies have demonstrated that the unique phenomenon ATP aerobic synthesis on neutrophilic plasma membranes is observed when neutrophils are activated with the chemoattractive peptide FMLP. This paper presents the results of the study of a possible association of ATP plasma membranous synthesis with priming, with the occurrence of respiratory explosion and apoptosis of the neutrophils isolated from the blood of donors and patients with surgical infection of different severity. The interaction of neutrophilic plasma membranes with FMLP and with hTNF (was attended by ATP synthesis. Examining the level of FMLP-stimulated production of superoxide in patients with surgical infection revealed that the amount of the superoxide produced by neutrophils noticeably decreased and droppped by more than 5 times in sepsis. The FMLP-stimulated plasma membranous synthesis of ATP was determined in the same patients. A decrease in the production of superoxide was simultaneously accompanied by a reduction in the plasma membranous synthesis of ATP. Both the plasma membranous synthesis of ATP and the production of superoxide declined in sepsis at the most. The neutrophils isolated from peripheral blood of the same patients showed DNA damage whose degree was directly related to the condition of a patient. The maximum DNA damages were observed in sepsis. The findings suggest that apoptosis is induced in surgical infection in the peripheral neutrophils. The DNA damage and the FMLP-stimulated plasma membranous synthesis of ATP was estimated in the neutrophils isolated from the inflammation focus. It turned out that in local surgical infection, there were the maximum DNA damages and the FMLP-stimulated plasma membranous synthesis of ATP was lower than that in the peripheral neutrophils. It can be suggested that the FMLP-stimulated plasma membranous synthesis of ATP may be a regulators of neutrophilic functional states in surgical infection and sepsis.

[Effects of some growth factors and cytokines on ATP synthesis by plasma-membrane-enriched particles isolated from different human tumors]. / Vliianie nekotorykh faktorov rosta i tsitokinov na sintez ATF preparatami obogashchennykh plazmaticheskimi membranami chastits, izolirovannykh iz razlichnykh opukholei cheloveka.

Plasma-membrane-enriched particles isolated from the tissues of malignant tumors of different sites are shown to accumulate ATP under the influence of polypeptide growth factors and cytokines whose receptors have a tyrosine kinase activity. Polypeptide growth factors, such as EGF, FGF, NGF, TNF, insulin, and the cytokine IL-2, were studied on the accumulation of adenosine-5'-triphosphate (ATP) by the preparations of plasma-membrane-enriched particles isolated from the target tissues of human malignant tumors. The tumor (transformed) cell plasma membranes of the lung, bowel, stomach, pancreas, as well as the cells of neurinoma and a retroperitoneal extra-organ malignant tumor (leiomyosarcoma) are demonstrated to be able to synthesize ATP from inorganic phosphate and ADP under aerobic conditions human with the participation of the cyanide-insensitive proton phoric NADH-bound transversely oriented chain. Signal-stimulated accumulation of plasma membranous ATP was found to increase in the tissues in malignant transformation as compared to that in normal tissues. Experiments using selective inhibitors of tyrosine kinases (tyrphostin-25, quercetin) indicated the involvement of plasma membranous signal-transducing ATP in the activation of receptor tyrosine kinase growth factors.

TNF alpha-induced aerobic synthesis of ATP on plasma membranes of target cells. The relation to the expression of the nuclear oncogene c-myc.

The accumulation of ATP by preparations of plasma membranes enriched particles (PMEP) isolated from rat hepatocytes, murine splenocytes and human T-lymphocytes has been investigated after the binding of human and murine tumour necrosis factors (TNF alpha) to their specific receptors. The TNF alpha-induced expression of the nuclear oncogene c-myc in intact hepatocytes has been also studied. TNF alpha induced the marked biosynthesis of ATP on PMEP of hepatocytes and splenocytes within the first minute of incubation. The biosynthesis of ATP was independent of the activity of adenylate kinase and only occurred in the presence of all the components of aerobic phosphorylation and the electron acceptor, cytochrome C or diferric transferrin. The level of ATP on PM correlated with the degree of expression of the nuclear oncogene c-myc in the same target cells. Adriamycin totally suppressed the biosynthesis of ATP on PM and simultaneously inhibited the expression of c-myc. The ATP synthesized on PM is suggested to be involved in transduction of the proliferative or growth signal to the cell nucleus.