[Multiple endocrine neoplasia syndrome type 2].

Multiple endocrine neoplasia (MEN) syndrome--is a hereditary disease which is characterized by synchronous or metachronous development of benign (adenoma, hyperplasia) or malignant tumors in the endocrine organs. The presence of medullary thyroid carcinoma and pheochromocytoma are mandatory requirements of MEN 2 syndrome. The purpose of our study was to perform timely diagnosis and optimal surgical treatment of patients with MEN 2 syndrome. Over the 1999-2009 years in the clinic we have diagnosed the MEN 2 syndrome in 5 patients, of whom two women were sisters. In all patients we observed medullary thyroid carcinoma and pheochromocytoma. Two patients had bilateral pheochromocytoma, and the clinical course was characterized with mild arterial hypertension. Primary hyperparathyroidism was observed in 2 patients. In the near relatives of patients with MEN 2 syndrome it must measure calcitonin, catecholamines, calcium rate, conduct ultrasound examination of the neck and retroperitoneal space.

[Application of video-assisted parathyroidectomy for treatment of primary hyperparathyroidism].

During the last years for surgical treatment of primary hyperparathyroidism minimally invasive operations were applied. The results of the introduction of video-assisted parathyroidectomy in the clinic in 8 (32%) of 25 patients with primary hyperparathyroidism, who were operated during the 2010-2012 were analysed. Video-assisted parathyroidectomy compared to conventional operation allowed to reduce significantly the duration of the operation, to reduce the incidence of postoperative complications, to achieve a better cosmetic effect.

[Carcinoids of pancreas and digestion canal clinical signs, diagnostics and surgical treatment].

The review of the literature is presented and results of diagnostics and treatment of 28 patients with carcinoid tumours of the digestion canal of various localization are analysed. Carcinoids were both hormone-active, and hormone-inactive. Before the operation the diagnosis of carcinoid syndrome has been established only for two patients. Carcinoid tumours of a liver were in 4 patients, a gall bladder - in 1, a pancreas - in 5, a stomach - in 1, a duodenum - in 1. Results of methods of laboratory and instrumental examination are given and corresponding conclusions are made.

[Adrenal tumours: diagnosis and modern surgical methods of treatment, including minimale invasive].

The results of diagnosis and treatment of 759 patients (aged from 8 to 78 years) with adrenal diseases were analyzed. A variety of clinical symptoms depended on the adrenal layer lesion. We analyzed the results of biochemical and instrumental methods of examination of patients, hormone levels in the blood, methods of preoperative preparation of patients, postoperative complications. The results of minimally invasive surgery of adrenal tumors were presented. From 1997 till 2010 endoscopic adrenalectomies performed in 81 patients.

[Possibilities of radical surgical treatment of patients with tumoral obstruction of extrahepatic biliary ducts].

Experience of radical surgical treatment of 32 patients, suffering extrahepatic biliary ducts (EBD) tumor, was analyzed. The respectability index of a Clatskin tumor have constituted 12.5%, and of the EBD middle portion--25%. In 8 patients an open operative intervention was performed and in 1--laparoscopic procedure was applied. The respectability index of a distal EBD tumors have constituted 29.6%. Postoperative lethality was 15.6%.

[The need for liver transplantation in adult population of the Lviv region]. / Potreba u peresadtsi pechinky u dorosloho naselennia L'vivs'koï oblasti.

Hepatic transplantation constitutes a modern standard of a medical care giving to the patients with some diseases of this organ. According to the Lviv regional pathologomorphological bureau data there were choosed and analyzed in detail 144 observations of the persons, died for the 6 years period due to hepatic pathology owing. The annual maximal quantity of retrospectively--possible recipients of liver constitutes 18.3 persons, minimal--14.8 persons. Maximal index of the Lviv region adult population necessity for hepatic transplantation constitutes 8.3 interventions to 1 million of citizens, minimal one--6.7. Regional nosologic structure of the hepatic transplantation necessity corresponds with the world tendencies present.

[Treatment of an acute cholecystitis in elderly and senile patients with diabetes mellitus]. / Likuvannia hostroho kholetsystytu u khvorykh na tsukrovyi diabet pokhyloho i starechoho viku.

Results of surgical treatment of an acute cholecystitis (ACH) in 114 elderly and senile patients with diabetes mellitus were analyzed. In all operated patients histological investigation revealed destructive forms of an ACH, mainly complicated. After the operation in 14 (12.3%) of patients complications occurred. Tactics of treatment was based mainly on securing of adequate correction of carbohydrate metabolism before, during and after performance of operation and also on early performance of cholecystectomy using laparoscopic method, permitting to reduce frequency of postoperative complications occurrence and to lower postoperative lethality.

[Optimization of complex treatment of purulent cholangitis]. / Optymizatsiia kompleksnoho likuvannia hniinoho kholanhitu.

The results of treatment of 53 patients with purulent cholangitis were analyzed. In complex of treatment there were applied hemocarboperfusion and nondirect electrochemical oxygenation of the blood. It had promoted the lowering of the endogenic intoxication severity and the oxygen-transporting system of blood improvement.

[The surgical treatment of toxic goiter in middle-aged and elderly patients]. / Khirurhichne likuvannia toksychnoho zoba u khvorykh pokhyloho ta starechnoho viku.

Of 128 patients, ageing more than 60 years, polynodular toxic goiter was diagnosed in 84, diffuse toxic goiter--in 34, toxic adenoma--in 10. The nodules in thyroid gland (TG) were revealed in 94 patients, cancer--in 3. There were following indications for the operation: the lack of the thyreostatic therapy efficacy, the malignant-like nodules presence, compression of cervical and mediastinal organs. After the euthyreotic state achievement all the patients were operated on using endotracheal narcosis. Subtotal resection of TG was performed in 91 patients, thyroidectomy--in 27, hemithyroidectomy--in 10. The frequency of specific complications (n. recurrence damage, bleeding, hypoparathyroidism, the wound purulent complication) was 4.7%.

[The treatment of metastasis of liver cancer]. / Likuvannia metastatychnoho raku pechinky.

Of 1483 patients with malignant tumors, treated in 1992-1997 years in clinic, metastasis in liver were revealed in 304 (20.5%). Surgical treatment was performed in 23 (7.6%) patients, in 17 (78.3%) of them hepatic resection with metastasis was done: anatomic--in 4, atypical--in 13. In superficial localization of metastases in 5 (21.7%) of patients the thermo-destruction of tumor was done. Postoperative complications had occurred in 5 (29.4%) of patients. Two (8.7%) patients died. An early diagnosis and thoroughly selection of patients for performance of operation had promoted an effective radical treatment of patients with metastatic hepatic cancer.

[The classification of cystic lesions of the pancreas]. / Do pytannia klasyfikatsiï kistoznykh urazhen' pidshlunkovoï zalozy.

The paper focuses on different classifications of cystic affections of the pancreas. The most simplified classification is proposed to be used in routine practice, which facilitates clinical recognition and permits the selection of optimum, in the first place, surgical, tactics.

[The diagnosis and surgical treatment of primary malignant liver tumors and metastases]. / Diahnostyka ta khirurhichne likuvannia pervynnykh zloiakisnykh pukhlyn pechinky i metastaziv.

Results were analyzed of diagnosis and treatment of 314 patients with malignant tumours of the liver. Of these, 36 had primary tumours of the liver (PTL), 278 were presenting with metastatic tumours (MTL). In addition, an analysis was carried out in 1236 oncological patients in order that the frequency of metastasizing of tumours into the liver might be determined together with the specific weight of metastases of different locations. The rates of tumours metastasizing to the liver were found out to be 45.7, 33.3, 30.1 percent with the gallbladder, major duodenal papilla, stomach respectively. Ultrasonography is an effective diagnostic tool for malignant tumours of the liver, being of great informative value (sensitivity in PTL--97.2%, MTL--75.7%). Eight (22.2%) patients with PTL and seventeen (6.1%) ones with MTL underwent surgical treatment. The only radical modality of treatment is still anatomical resection of the liver. Investigations are under way designed to study efficiency of thermo-(cryo) destruction of solitary and single liver metastases if surgical resection is beyond the bounds of possibility.

[The treatment of colorectal cancers]. / Likuvannia kolorektal'noho raku.

Results of treatment of 2900 patients with colorectal cancer in 1972-1994 yrs. period are analyzed. Diagnosis methods, kinds of operative procedures, frequency of complications occurrence are enlightened. Problematic directions of future investigations are determined.

[The mechanism of the effect of insulin on the interhormonal relations of androgens and glucocorticoids in the body]. / Mekhanizm vplyvu insulinu na mizhhormonal'ni vidnoshennia androheniv ta hliukokortykoïdov v orhanizmi.

Forty-six essentially healthy persons, 96 patients with carcinoma of the stomach (stage II, III and IV), 26 patients with idiopathic aseptic necrosis of the head of the femur and 42 patients in the time course of their medical condition related to traumata were studied for changes in the excretion of metabolites of androsteroidogenesis and glucocorticoids under the influence of insulin. It has been established that insulin actions on steroidogenesis depend upon interhormonal relations of androgens and glucocorticoids under their values being low, insulin stimulates androsteroidogenesis and reduces the production of glucocorticoids, while their high values are associated with activation of hypothalamic-pituitary-adrenal axis due to insulin hypoglycemia, with the production of glucocorticoids rather that androgens tending to be on the increase. There has been revealed for the first time the ability of insulin to stimulate, under dyscorticism, androsteroidogenesis and lower the production of glucocorticoids, which facts permit recommending the use of insulin to lessen catabolic, contrainsular, and immunodepressive effects of glucocorticoids in the organism.

[The differential assessment of the state of lipid peroxidation and of the antioxidant system in patients in the late period after gastric resection]. / Dyferentsiiovana otsinka stanu perekysnoho okyslennia lipidiv ta antyoksydantnoï systemy u khvorykh u viddalenomu periodi pislia rezektsiï shlunka.

Studied after stomach resection for ulcer disease in 161 patients were lipid peroxidation (LPO), antioxidant system (AOS) and related parameters characterizing metabolism of carbon (Lactat), protein (piruvat) and fat (fat acids, lipoproteins), an indicator of the dystrophic change degree (acid phosphatase). Revealed in these patients was syndrome of peroxidation, which leads to disturbances of protein, carbon and fat metabolism, destruction of cell membranes. Increased, "normal", weakened LPO was identified in 67.7%, 9.94%, 22.36% of the patients respectively. In patients with an increased LPO statistically significant activation of AOS was established, lactate having increased more than twice, pyruvate remaining unchanged; the level of fat acids and lipoproteins almost doubled. In such a situation it is reasonable to use preparations which activate aerobic glycolysis, and antioxidants of a direct, mild degree, action. In group II patients with more prominent increase in the acid phosphatase activity preference should be given to membrane-stabilizing preparations. In patients with a decreased level of LPO considerable increase in lactate and acid phosphatase was noted. It is recommended that preparations promoting normalization of carbon and lipid metabolism, enhancement of redox processes in the respiratory chain should be included into complex therapy as should be stabilizers of membranes of cell organelles, with biogenic stimulators to follow.