[Cardiac hydatid cyst]. / Ekhinokokkoz serdtsa: klinicheskoe nablyudenie.

Echinococcosis is one of the most common parasitic diseases. Most often, echinococcosis affects the liver and lungs. Difficult diagnosis of hydatid disease is determined by scanty symptoms. Additional difficulties arise in echinococcosis of rare localizations. Cardiac echinococcosis occurs in less than 2% of cases. However, incidence of complications and mortality are much higher in these patients. The authors report successful surgical treatment of cardiac hydatid cyst..

[TELOMERASE ACTIVITY AS A POTENTIAL BIOMARKER FOR PREOPERATIVE DIFFERENTIAL DIAGNOSIS OF CYSTIC NEOPLASMS OF THE LIVER].

The goal of the study was to find ways to improve the quality of preoperative diagnosis of mucinous cystic liver neoplasms using such tumor markers as CA 19-9 and telomerase activity. We conducted a retrospective analysis and a prospective study that included the results of treatment of 80 patients with cystic neoplasm of the liver (31 with MCNL, 36 with multichamber non-parasitic cysts (NPC), 13 with stage II (WHO classification) echinococcus liver cysts. Our study showed the presence of telomerase activity in 29 (93.5%) patents with MCNL (in case of IMCNL, the TA was high both in the tumor itself and the CNL content).16 patients demonstrated high TA (+++) both in the tumor itself and the CNL content; 11 and 2 patients had moderate (++) and low (+) TA, respectively. 12 (38.7%) patients with MCNL had the CA 19-9 level above 1000 U/L, 14 (45.1%) - above 10,000 U/L, and 3 (9.6%) - above 100,000 U/L, while only 1 (6.5%) patient had the CA 19-9 level <1000 U/L. The analysis of data showed the absence of TA in the CNL content in 33 of 36 patients with NPC. However, three patients demonstrated a low activity of telomerase. CA 19-9 levels were below 1000 U/L in 27 (75%) of 36 patients with NPC. It was established that the determination of TA and the level CA 19-9 in the contents of the CNL is a valuable method, which makes it possible to carry out a preoperative differential diagnosis of CNL with a high probability.

[Choice of surgical approach to insulin-producing pancreatic tumors]. / Vybor metoda khirurgicheskogo lecheniia insulinprodutsiruiushchikh opukholei podzheludochnoi zhelezy.

AIM: To determine the optimal surgical approach to insulin-producing pancreatic tumors via an analysis of early postoperative results. MATERIAL AND METHODS: There were 134 patients with insulin-producing pancreatic tumors followed by organic hyperinsulinism who have undergone surgery in the faculty-based surgical clinic of the Sechenov First Moscow State Medical University for the period 1990-2017. Patients were divided into three groups depending on type of surgical intervention. Surgical procedure was determined after comprehensive preoperative and intraoperative examination including intraoperative ultrasound. RESULTS: Incidence of postoperative complications was 32.8%. Ten (7.5%) patients required redo surgical interventions. Overall postoperative mortality was 4.5%. The best immediate results were observed in patients undergoing distal pancreatectomy. There was a correlation between incidence of early postoperative complications and tumor location depth in the enucleation group. CONCLUSION: Enucleation is advisable for insulinoma of pancreatic head or uncinated process, as well as superficial tumors of the left half of the pancreas. Distal pancreatectomy is indicated for deep tumors of the left half of the pancreas. Indications for pancreatoduodenectomy are individual.

[Massive abdominal hydatidosis]. / Total'noe porazhenie briushnoi polosti ékhinokokkozom.

Clinical symptoms and localization of echinococcosis are various. Clinical observation of successful surgical treatment of secondary multiple abdominal lesion with echinococcosis is presented in the article. Certain features of diagnosis and surgical treatment are described.

[Echinococcosis and pregnancy: approaches to the treatment]. / Ékhinokokkoz i beremennost': podkhody k taktike lecheniia.

AIM: To develop treatment strategy in pregnant women with liver echinococcosis. MATERIAL AND METHODS: There were 21 women with confirmed diagnosis of liver echinococcosis who were divided into 2 groups. Group I consisted of 17 patients with cysts Charbi grade I-III. They underwent percutaneous puncture and antiparasitic management of the cyst under intravenous sedation. Group II included 4 patients with cysts grade IV-V and those with multiple cysts. They underwent conventional surgery. RESULTS: In one patient, fetal death occurred in 20 hours after surgery and it was not associated with the procedure. There were no complications in other patients. Uneventful childbirth was noted in all of them. CONCLUSION: Percutaneous puncture in the second trimester of pregnancy is effective and safe procedure for prevention of complications of echinococcosis in late pregnancy and childbirth. Conventional surgery is alternative if percutaneous intervention is not advisable.

[Giant posttraumatic diaphragmatic hernia in 17 years after rupture of the diaphragm]. / Lechenie gigantskoi posttravmaticheskoi diafragmal'noi gryzhi cherez 17 let posle razryva grudobriushnoi pregrady.

Blunt chest trauma followed by diaphragm rupture is a severe injury requiring surgical correction both in acute and long-term periods. Posttraumatic diaphragmatic hernia is dangerous by infringement of dislocated organs. Thanks to adaptive mechanisms of the organism, patients with non-functioning half of the diaphragm have a good quality of life for a long time. Symptoms (respiratory disorders and arrhythmia, predominantly) occur over time in patients with concomitant diseases and impaired function of vital organs. At the same time, simultaneous thoracic and abdominal surgery is possible. Thoracotomy is advisable for injury of the right half of the diaphragm, thoracotomy and laparotomy - for injury of the left half. It is presented case report of diaphragm repair by primary suture without application of strengthening materials in 17 years after complex trauma. In this case, diaphragm function was restored that resulted improved quality of life.

Combined treatment of nonresectable cholangiocarcinoma complicated by obstructive jaundice.

BACKGROUND: The five-year survival rate for successful surgical treatment of cholangiocellular cancer is only 20-40%, and in the case of an unresectable tumor, the life expectancy does not usually exceed 6 months. Survival decreases with the presence of jaundice, due to the spread of the tumor process along the bile ducts, leading to their obstruction. We report outcomes of patients with nonresectable bile duct carcinoma complicated by obstructive jaundice treated with Photodynamic Therapy (PDT). METHODS: Combined diagnosis and treatment included percutaneous cholangiostomy, intraductal video fluorescence diagnostics, photodynamic therapy, and bile duct stenting. All patients were treated at the Sechenov University Oncology Center in Moscow. The results of treatment of 33 patients have been presented. The intraductal diagnosis of malignant bile duct lesions was performed after cholangiostomy using the endovideofluorescence module for minimally invasive surgery and endoscopy. With the use of this method, it is the first time in Russia that it has become possible to obtain a videofluorescent image of the tumor and to determine the high level of photosensitizer accumulation in all cholangiocarcinoma patients. The preparations Photolon, Radachlorin, and Photosens were employed as photosensitizers (PS). Intraductal photodynamic therapy was used to achieve the antitumor effect. Laser power density was about 200 mW/cm2. RESULTS: We present initial results, improved the diagnostic possibilities in this difficult localization of carcinoma, and demonstrated the feasibility of prolongation of life without significant deterioration of its quality. The average survival time in the treatment group is 9.5 months. CONCLUSION: The treatment of patients with nonresectable cholangiocarcinoma with Photodynamic Therapy should be an available option. In this context, the additional use of intraductal endovideofluorescence diagnostics is a highly specific technique that allows reliable detection of the photosensitizer accumulation predominantly by the tumor tissue and appears promising. As shown by our experience, flourescent localization followed by Photodynamic Therapy, enabled us to improve diagnostic techniques and treat the tumor with improved outcome.

[EFFICACY OF A NEW MEBENDAZOLE FORMULATION FOR EXPERIMENTAL ECHINOCOCCUS GRANULOSUS LARVAL INVASION IN ALBINO MICE].

The problem of echinococcosis has acquired special urgency in Russia in the last 10 years. The dramatically worse epidemiological situation of echinococcosis in the country is suggested by just frequent cases of cystic echinococcosis in the indigenous population of Moscow and its region, including children. Currently, albendazole that is less toxic than mebendazole remains the drug of choice, However, some authors note that E. granulosus larval cysts are moresusceptible to mebendazole than to albendazole. Both drugs mainly show parasitological activity and have no larvicidal effect particularly in larval alveococcosis. Analysis of the results of chemotherapy, with a group of benzimidazole carbamates for echinococcosis in 6 clinical centers from 5 European countries (Italy, Bulgaria, Romania, Greece, and Turkey) over the past 30 years showed that the evaluation of therapeutic effectiveness was overestimated; thus, 40% of all parasitic larval cysts that were considered dead became active again after, 2 years after the treatment. The original oil micronized mebendazole suspension tested by us in albino mice with late-stage larval cystic echinococcosis showed the properties of a highly effective and safe systemic larvicide that caused prompt death in the entire parasite population in the treated animals even in extreme hyperinvasion when the baseline parasite weight was greater than the host's one.

[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.

[Neuroendocrine tumors of a pancreas: 30 year's experience of clinic of faculty surgery of N.N. Burdenko].

N.N. Burdenko surgery clinic have an experience of treatment of 342 patients with gastroenteropancreatic neuroendocrine tumors. Original algorithms of diagnosis, complex treatment and postoperative management were applied. We achieved 100% five-year survival rate after radical surgery and reduced postoperative complications 1.6 times.

[The surgical treatment of hydatid disease of liver and lungs: the state of art].

Results of surgical treatment of 65 patients with the combined hydatid disease were analyzed. Lung invasion was combind with liver cysts in 57 patients, spleen -- in 2 patients, soft tissues of the thorax - in 2 patients and retroperitoneal cysts were found in 3 patients. Lung echinococcectomy with the use of minithoracotomy proved to be a method of choice. The access permits early recovery and shorter rehabilitation period, allowing to perform the second liver surgery on the 3--7th day after the first operation.

[Prognostic factors of the immediate results of surgical treatment of organic hyperinsulinism].

The clinic obtains the experience of treatment of 245 patients with organic hyperinsulinism. The main goal of the treatment of that category of patients is an improvement of immediate results of surgical treatment which leads to the decrease in mortality level. Authors set the diagnostic and intra- and postoperative treatment algorithm, as well as the major prognostic factors of postoperative morbidity rates. The use of the algorithm allowed the 1,5 decrease in postoperative morbidity and twice decreased the lethality rate.

[Echinococcosis of the heart].

Basic clinical and special methods of diagnosis of cardiac echinococcosis are described. Among 12 patients with cardiac echinococcosis 5 patients have been operated and 7 patients have been not. Five of seven non-operated patients died during 1 year due to disruption of the cysts. All 5 operated patients survived. It is demonstrated that surgical treatment should be performed with artificial extracorporeal circulation, and postoperative anti-recurrent anti-helminth therapy is mandatory. Medication before surgical procedures is contraindicated because it leads to cysts disruption with high risk of lethal outcome.

[The specific features of development of Echinococcus granulosus metacestode (exogenous blastogenesis) in man].

The paper describes a case of abnormal development of a parasitic cyst by the type characteristic of alveolar echinococcosis (exogenous blastogenesis) detected in a female patient operated on for echinococcus. The fact that the exogenous blastogenesis has been found allows the mechanism of a postoperative recurrence of human echinococcosis to be explained from basically new standpoints. A parasitological analysis of the punctates of cystic masses and cysts themselves, taken from patients operated on for cystic echinococcosis has revealed one of the signs of malignant exogenous proliferation of elements of a parasytic metacestode, namely, the development of acephalocysts from the germinative cells of the pedicle of protoscoleces. The capacity of cystic echinococcosis metacestodes for exogenous blastogenesis by the type of human alveolar echinococcosis is an early unknown species-specific feature of E. granulosus.

[Diagnosis and choice of surgery of non-parasitic cysts of the liver]. / Diagnostika i vybor metoda khirurgicheskogo lecheniia neparazitarnykh kist pecheni.

Results of treatment of 342 patients with non-parasitic cysts of the liver (NCL) were analyzed. Based on obtained data diagnostic algorithm was developed. Indications and contraindications for transcutaneous and laparoscopic methods in NCL are clarified and substantiated. Features of laparoscopic operations in different location of cysts are presented. In mini-invasive surgeries postoperative complications rate was minimum, there were no lethal outcomes. The authors believe that conventional surgeries in NCL should be performed in critical states only.