[The possibilities for the restoration of the laryngeal function: the current state-of-the-art]. / Vozmozhnosti vosstanovleniia funktsii gortani: sovremennyi podkhod.

The restoration of the functional competence of the larynx following bilateral laryngeal nerve damage and vocal fold paralysis is a serious challenge for the surgeon that has thus far no satisfactory solution. Physiological re-innervation that occurs naturally with time is non-selective and, in the majority of the cases, leads to synkinesis. Laryngeal pacing achieved with the application of the implantable microchips appears to be a promising approach. The animal experiments have demonstrated the possibility of successful restoration of all the functions of the larynx by means of laryngeal pacing but simultaneously revealed a number of technical issues that have to be addressed if the further progress in this field is to be achieved including the choice of the proper materials for implantation, solution of problems pertaining to the neuromuscular mapping during pacer implantation, etc.). The results of the first prospective clinical trial involving the human patients gave evidence suggesting that the laryngeal electrostimulation technology is both safe and efficient. Nevertheless, further investigations and modification of the method are needed before it can be recommended for the wider application in the routine clinical practice.

[Diagnosis and surgical treatment of adrenocortical cancer with invasion into great veins]. / Diagnostika i khirurgicheskoe lechenie adrenokortikal'nogo raka s invaziei v magistral'nye venoznye sosudy.

AIM: To estimate immediate and remote resaults of treatment of adrenocortical cancer with invasion into great veins. MATERIAL AND METHODS: It was analyzed survey and treatment results in 3 patients with adrenocortical cancer and invasion into renal veins and inferior vena cava. RESULTS: Radical surgery with tumoral thrombi removal from great vessels was performed in all cases. There were no complications and deaths in early postoperative period. Life expectancy after surgery was 6, 13 and over 58 months. CONCLUSION: At present time surgical intervention for adrenocortical cancer with invasion into great veins is single method to prolong patients' life.

[Complex ultrasonic study of parathyroids in diagnostic and surgical treatment of primary hyperparathyroidism].

Primary hyperparathyroidism is the most common disease in Russian Federation, cured by endocrine surgeons. Health status after surgical correction of primary hyperparathyroidism depends on availability of screening hypercalciemia, which is still absent in our country. Another problem is a model of surgical management of primary hyperparathyroidism (frozen section, intraoperative monitoring of parathyroid hormone, gamma-detection and so on). Although minimally invasive parathyroidectomy has become the only method of treatment in many countries, it is still crucial to identify and accurately localize parathyroid glands before bilateral neck exploration surgery. The diagnostic efficacy of the various imaging techniques is still the subject of current debate. The usefulness of preoperative parathyroid imaging with both dual scintigraphy-single-photon emission computed tomography (SPECT) Tc 99m and high-resolution ultrasonography (US) was studied in 92 patients undergoing operations for primary hyperparathyroidism. The accuracy of "integrated" ultrasonography ("check-up US", "target US" after SPECT) and "intraoperative US") of parathyroid glands was 92.9%, sensitivity - 91% and positive predictive value - 94%. This study supports an algorithm of obtaining "integrated" ultrasonography as the initial and in most cases the only preoperative localization tests for patients with primary hyperparathyroidism.

[Surgical and endovascular treatment of lung arteriovenous malformations].

The article summarizes the experience of surgical treatment of 47 patients (1964-2012 yy) with lung arteriovenous malformations (LAVM). Men were 29, women - 18. Age varied from 6 to 49 years. 20 patients had solitary lung arteriovenous malformations, the rest 27 had multiple malformations. Before 1983 the main diagnostic means was the angiopulmonography, since that the multyspiral computed tomography has been used. Before 1980 all patients received major surgical treatment, i.e., lobectomy (n=29), pneumonectomy (n=1) and 1 explorative thoracotomy. After 1980 the endovascular embolisation under the X-ray control took the leading place among the treatment options for these patients. 11 patients had 17 embolisations; the lung resection was performed only in 3 cases. All negative outcomes (4 lethal and 8 complications) were registered before the 1980. The were no lethal outcomes after the endovascular embolisation; only 3 patients had complications. All patients demonstrated satisfactory and good outcomes, considering objective parameters and quality of life early and long after the endovascular embolisation.

[Development of a set of diagnostic test systems for analysis of expression of C-myc, mad1, max, p53, and E2F1 gene oncomarkers by the reverse transcription reaction-polymerase chain reaction alignment technique].

Based on the performed studies, the authors developed test systems to analyze the expression of mRNA of the p53, C-myc, mad1, max, and E2F1 genes. These test systems could reveal a statistically significant difference between follicular adenoma and carcinoma of the thyroid in their expression of p53 mRNA. It should be noted that the use of our developed test systems is promising when searching for the diagnostic and prognostic markers of cancer, analyzing, and creating the genetic networks characterizing this or that cancer.

[Puncture hystobiopsy with tissue telomerase activity measurement in preoperative thyroid nodes diagnostics].

Demonstrated, that puncture thyroid hystobiopsy is safe and informative method of preoperative thyroid nodes diagnostics. Telomerase activity in tissue samples was significantly higher in case of malignant thyroid disease, although a positive correlation of telomerase activity was also with the amount of lymphocytes in bioptates. Combination of thyroid hystobiopsy with tissue telomerase activity measurement proved to be an effective means of preoperative diagnostic of patients with nodular goiter.

[Long-term prognostic analysis of surgical treatment of the thymoma-associated myasthenia gravis].

Treatment results of 300 patients with myasthenia gravis (MG) were analyzed. 150 patients with MG and thymoma formed the main group, the rest 150 patients with non-thymomatous MG comprised the group of control. Thymomatous myasthenia was more severe and resistant to therapy. 79 (48.7%) patients had thymoma type B, mixed thymoma type AB was found in 45 (30.0%) patients, the rest had medullary tumors type A. I stage of the tumor progression was registered in 62.0% of cases, stage III was the second to find among them (20.0%). Long-term follow-up revealed stable and statistically proved improvement of MG clinic in patients of the main group (p=0.013). Survival rate of patients with thymoma and MG were 91.2, 83.4 and 72.3% after 3-, 5- and 10 years, correspondingly. Survival rates for non-thymomatous MG were significantly higher: 96.0, 91.6 and 87.2% after 3-,5- and 10 years, correspondingly. Tumor characteristics showed no influence on MG course after the operation. As well, as for the patients of the control group, only severity of the disease was the significant factor for the MG prognosis. Oncological prognosis was defined by pathomorphological type of thymoma and its progression stage. Thymomthymectomy allowed not only tumor remission but also myasthenia course stabilization and improvement.

[Long-term results of surgical treatment of thymomas at the patients with generalized myasthenia].

Results of diagnosis and treatment of 150 patients with thymoma and generalized myasthenia are analyzed. The results of examination were registered before surgery, and also in 1, 3, 5 and 10 years after one. It is demonstrated that thymoma is potentially malignant tumor with risk of recurrence and requires long follow-up of patient after operation. Morphologic type and stage of tumor, severity of myasthenia are the main predictors in the prognosis of surgical treatment. Thymomectomy with excision of fatty tissue of anterior mediastinum is absolutely indicated for this severe category of patients, and it decreases the risk of tumor progression. Mortality of patients depends not only on tumor growth or recurrence but also on concomitant myasthenic disorders.

[Anti-Titin-antibodies at the patients with myasthenic and non-myasthenic thymoma].

Serum specimens from 52 myasthenic patients with thymoma of various histological characteristics and 4 patients with thymoma without myasthenia have tested for anti-Titin-antibodies titer. It has been demonstrated that organ-specific thymoma dominated at myasthenic patients, and organ-nonspecific thymoma - at the patients without myasthenia. There was no correlation between severe clinical symptoms and the level of anti-Titin-antibodies. The titer of antibodies at the patients with organ-specific thymoma was higher that at ones with organ-nonspecific thymoma, but there was no correlation between the level of anti-Titin-antibodies and histological type of organ-specific thymoma.

[Disputable problems in diagnosis and treatment of catecholamine-secreting tumors].

The article covers the main problems and disputable points in diagnosis and treatment of pheochromocytoma: differential diagnosis before surgery and treatment which policy. The authors define a specific group of patients required a comprehensive deep examination (group of risk) for chromaffin tissue. Differentiated use of different methods of diagnosis of catecholamine-secreting tumors is validated. Some last est negative tendencies in adrenal surgery are also discussed.

[Disputable points and negative tendencies in diagnosis and surgical treatment of accidentally revealed adrenal tumors].

Two main problems are discussed in detail: differential diagnosis of adrenal tumors before surgery, and policy of treatment of these patients. Indications for fine needle biopsy are determined, based on personal and world experience reasoned indications to surgical treatment and follow-up are formulated. Some negative tendencies in adrenal surgery are also discussed.

[Forty-year experience of surgical treatment of generalized myasthenia]. / Sorokaletnii opyt khirurgicheskogo lecheniia generalizovannoi miastenii.

Forty-year experience with surgical treatment of generalized myasthenia (GM) based on 2977 cases is analyzed. Role of special methods of mediastinum examination (CT, MRT) is demonstrated, indications to thymectomy are validated. It is noted that developed diagnostic algorithm, surgical technique, management before and after surgery improved significantly immediate and long-term results. Development of clinical, immunological and morphologic criteria of thymectomy effect permitted to predict course of GM and to optimize complex therapy after surgical treatment.

[Surgical treatment of thymomas in patients with generalized myasthenia gravis]. / Khirurgicheskoe lechenie timom u bol'nykh generalizovannoi miasteniei.

Experience in surgical treatment of 2977 patients with generalized myasthenia is presented, 386 (13%) of them have undergone surgeries for thymus tumors. Organo-specific tumors (thymoma) were diagnosed in 370 (95.9%) of them. Computed and magnetic-resonance tomography has the highest sensitivity and specificity in diagnosis of thymus tumors. Thymomthymectomy was performed in 317 patients including extended one in 117 (36.9%). Postoperative lethality in thymic tumor in the last years was 0.5%, general lethality over all period--5.1%. According to used classification (WHO, 1999) types of thymoma were the following: type A--2.1%, type B--86.3%, type AB--9.6%. Prognosis of surgical treatment depends of tumor type (it is worse in type B than in types A and AB), duration of the disease and severity of myasthenia.

[Current aspects of diagnosis and treatment of symptomatic arterial hypertension of adrenal genesis]. / Sovremennye aspekty diagnostiki i lecheniia simtomaticheskikh arterial'nykh gipertonii nadpochechnikovogo geneza.

AIM: To analyse the experience in diagnosis and treatment of arterial hypertension (AH) of adrenal genesis. MATERIAL AND METHODS: A total of 243 patients with adrenal AH (mean age 46.3 +/- 3.2 years) were examined. 134 of them had endogenic adrenohypercorticism (EAH), 62--primary hyperaldosteronism (PHA), 47--chromaffin tissue tumors (CTT). Diurnal urinary excretion of adrenal hormones (epinephrine, norepinephrine, aldosteron, hydrocortisone) and peripheral blood hormones (aldosteron, renin, hydrocortisone, ACTH) were measured. Topic diagnosis was made with ultrasound, computed tomography, MR-imaging, angiography, adrenal venous sampling and 123I-MIBG scintigraphy. RESULTS: Adrenalectomy was made in 224 patients (predominantly with tumor lesions). 19 patients (idiopathic hyperaldosteronism, advanced adrenocortical carcinoma) were treated conservatively (calcium antagonists, ACE inhibitors, AT1-receptor blockers, spironolacton). Good results of the surgical treatment were achieved in 60% patients with aldosterone-producing adenoma and adrenal Cushing's syndrome as well as in 80.5% patients with pheochromocytoma. Long-term outcomes depend on hypertension duration, histologic type of the tumor, age and family hypertension history (risk of essential hypertension). CONCLUSION: Hypertension of adrenal origin occurs more frequently than it was supposed previously. Its late diagnosis may be due to lack of typical signs and symptoms, insufficient application of novel diagnostic techniques and poor alertness of physicians. It is recommended to include tests for adrenal hormones in urine and blood and ultrasound investigation of the adrenals in a complex of primary examination of patients with severe refractory hypertension.

[False acute abdomen in clinical practice]. / Lozhnyi ostryi zhivot v klinicheskoi praktike.

Some situations in which endocrinological diseases and their complications (diabetic ketoacidosis, acute adrenal failure, pheochromocytoma, thyrotoxicosis, thyrotoxic crisis, hyperparathyroidism crisis) give the picture of false acute abdomen are analyzed.

[Tumors of chromaffin tissue (symptoms, diagnosis, surgical treatment)]. / Opukholi khromaffinnoi tkani (klinika, diagnostika, khirurgicheskoe lechenie).

Medical histories of 167 patients with tumors of chromaffin tissue were analyzed. Pheochromocytoma was diagnosed in 124 (74.2%) patients, pheochromoblastoma--in 32 (19.2%), extraadrenal tumor--in 11 (6.6%): paravertebral (4), between aorta and vena cava inferior (2), behind the tail of the pancreas (1), at lower pole of the kidney (2), in Zukerkandl's organ (1), in the urinary bladder (1). Complex examination (hormonal profile, US, CT, MRT) was carried out in all the patients, in difficult cases in 71 (42.5%) patients angiography was performed, and in 7 (4.2%)--scintigraphy. The device examination provided accurate diagnosis in all the cases. In the majority of patients (72) clinical picture of the disease was characterized by a typical crisis course. There were no clinical symptoms in patients with "silent" pheochromocytoma, tumor was revealed occasionally in all the cases. One hundred and sixty-four patients were operated. Total lethality was 3.6%. Long-term results were analyzed in 137 patients. Radical removal of pheochromocytoma led to stable normalization of arterial pressure in 73.2% patients. Non-invasive methods (polyposition US with colored doppler, CT, MRT) are methods of choice for topic diagnosis of pheochromocytoma. Sensitivity of US with colored doppler reached 94.3%.

[Diagnosis and surgical treatment of primary hyperaldosteronism]. / Diagnostika i khiururgicheskoe lechenie pervichnogo giperal'dosteronizma.

Primary hyperaldosteroneism (PHA) is one of the main causes of secondary arterial hypertension (AH). Medical histories of 62 patients with PHA were analyzed. aldosterone-produced adenoma (APA) was diagnosed in 37 (59.7%) patients (all of them were operated), idiopathic hyperaldosteroneism (IHA)--in 25 (40.3%) patients, 11 of them were operated. Complex clinical and instrumental examination (hormonal analysis, USI, CT, MRT, in difficult cases in 35 patients--selective phlebography with blood sampling) was carried out in all the patients. Clinical picture in the majority patients with PHA was unclear. Hypokaliemia is not obligatory symptom of PHA. AH is often the only symptom of PHA, therefore all the patients with AH require complex laboratory examination including repeated detection of potassium blood level, examination of serum aldosterone concentration and renin activity, diurnal urinary excretion of aldosterone. In difficult differential diagnosis between APA and IHA it is necessary to perform selective phlebography with blood sampling from inferior cava and adrenal veins with obligatory detection of aldosterone and hydrocortisone concentration. Diagnostic and curative algorithm are developed. Surgical treatment is indicated for patients with APA, and also for ones with IHA who had functionally dominant adrenal gland (based on selective blood sampling analysis) and resistant for drug therapy AH.