[Masculinizing mastectomy with nipple-areola graft autotransplantation for female-to-male transsexualism]. / Maskuliniziruyushchaya mammoplastika s autotransplantatsiei areol pri lechenii yadernoi formy zhenskogo transseksualizma.

OBJECTIVE: To develop the method of masculinizing mammoplasty with nipple grafting female-to-male transsexuals with BMI >30 kg/m2, large breast volume and severe ptosis. MATERIAL AND METHODS: There were 114 mastectomies in 57 patients with nipple grafting technique. The methods of areola grafting and scar design were modified to improve aesthetic results. Inclusion criteria were BMI >30 kg/m2, breast size B+ and severe ptosis (Regnault grade ≥2). Anonymous survey for evaluation of aesthetic outcome and quality of life was performed a year after surgery. RESULTS: Postoperative complications included hematoma (5.2%), seroma (7.9%), tangential graft necrosis (9.6%), wound dehiscence (0.8%), ligature-induced inflammation (1.7%), scar hypertrophy (12.2%). Three patients (5.2%) developed nipple hypersensivity in long-term postoperative period. Three patients (5.2%) required redo urgent surgery for hematoma. Additional surgical correction of scar hypertrophy was performed in 4 patients (7%). In a year after surgery, patients rated aesthetic postoperative result as 4.45 out of 5 scores. CONCLUSION: Masculinizing mammoplasty with areola autotransplantation is preferable for FtM transsexuals with large breast volume and severe ptosis. This surgery ensures a good aesthetic result with minimal secondary corrections and complication rate.

[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.

[Surgical stress in different cholecystectomies]. / Khirurgicheskii stress pri razlichnykh variantakh kholetsistéktomii.

For determination of surgical stress degree and evaluation of long-term results prospective randomized study was carried out. Three representative groups were compared: patients undergone traditional cholecystectomy (TCE)--95 patients (1 group), laparoscopic cholecystectomy--91 patients (2 group), minimally invasive cholecystectomy--92 patients (3 group). Level of stress hormones (before, during and after surgery), parameters of external respiration (before and after surgery), doses of analgetics (or their combinations) which were necessary for adequate analgesia in early postoperative period depending on surgical method were used as objective criteria of surgical stress. Based on evaluation of patients quality life reliable difference in first three years after surgery between patients undergone TCE and ones undergone minimally-invasive surgery was demonstrated.

[Laparoscopic and standard cholecystectomy: comparison of immediate results]. / Laparoskopicheskaia i traditsionnaia kholetsistéktomia: sravnenie neposredstvennykh rezyl'tatov.

The advantages of laparoscopic cholecystectomy (LChE) are undoubtable in comparison with traditional one. However the experience showed, that LChE is not devoid of some shortcomings. It is characterized by the same typical complications as in ChE, besides it may be followed by some specific complications. The literature concerning the rate of complications in LChE are controversial. The comparative analysis has been carried out concerning the rate of complications after ChE (6800 operations) and LchE (900). The mean age of patients with choledocholythiasis--61.4 years. 40% of the patients had severe accompanying diseases coronary artery disease, complicated forms of arrythmia, arterial hypertension, diabetes mellitus, obesity. There were no significant differences between patients who underwent ChE (group 1) and LChE (group 2) by their age and the rate of accompanying diseases. Intraoperative cholangiography was performed in 3.5% of cases of group 1 and in 1.1%--in group 2. The average rate of the operations on extrahepatic bile ducts in group 1 was also lower--choledocholithotomy was carried out in 2.7%, transduodenal papillosphyncterotomy--in 1.7% of cases, drainage of the choledochal duct--in 1.9%. Combined operations were carried out in 10% of patients of group 1 and in 9.1% cases of group 2. The rate of intraoperative bleedings which demanded repeated operations made up in patients of group 1 0.1%, in patients of group 2 0.5%. Intraoperative damage of the choledochal duct in group 1 were detected in 0.14% and in group 2--in 0.11% of cases (the only complication of LChE in a patient was assessed as a endogenous wall clipping).

[Combined operations for cholelithiasis]. / Sochetannye operatsii pri kholelitiaze.

The experience of 1560 combined operations performed in N.N.Burdenko clinic from 1974 to March 1999 for cholelithiasis is analysed. The results of 7461 cholecystectomies are analysed depending on patients' age (17.8% of patients aged 65 years and older), urgency of the operations (there were 35.6% of patients of this age group who underwent surgery under strictly urgent conditions), and complicacy of the operation (combined operations were carried out in 837 patients with cholecystitis). Last years in the clinic each 10th cholecystectomy is carried out as an additional procedure in more complicated surgery, or it is combined with less complicated one. Thus, in 389 patients with more complicated diseases than cholelithiasis (approximately in a half of them tumors of various locations were observed), cholecystectomy was performed as a combined procedure (1st group), and in 448 patients (2nd group) it was the main procedure. In the 1st group 27% of patients were aged 65 years and older, the overwhelming majority of the operations were carried out by the same approach, mortality rate being 3.3%. In the 2nd group elderly patients made up 20.7%; 68.3% of patients were operated by two approaches, lethality rate being 0.2%. Thus, lethality after 837 combined operations made up 1.7%, total mortality rate after 7461 cholecystectomies made up 0.29%.

[Cholecystectomy from mini-approach with the elements of open laparoscopic technique in surgical treatment of cholelithiasis]. / Kholetsistéktomiia iz mini-dostupa s élementami otkrytoi laparoskopicheskoi tekhniki pri khirurgicheskom lechenii zhelchnokamennoi bolezni.

The experience and the technique of cholecystectomy from mini-approach with elements of open laparascopic technique (MSE) in 102 patients with choledocholithiasis and calculous cholecystitis is descubed. In 99 cases the operation was carried out for chronic calculous cholecystitis, in 3 cases--for acute calculous cholecystitis. The patients were aged from 23 to 76 years (mean age 59.3 +/- 3.4 years). The average length of the incision in performing MSE made up 4.1 +/- 0.3 cm. Mean duration of the operation 42.4 +/- 5.3 min. In 5 cases (4.9%) intraoperative cholangiography was performed. The possibility to avoid the use of narcotic analgetics in postoperative period in patients who underwent MSE is demonstrated. Postoperative period made up 3.8 days. Social and cost-effect aspects of different modes of surgical treatment of patients with cholelithiasis are considered. The study of quality of life index makes it possible to come to conclusion about quicker return of the patients who underwent MSE to their habitual social and intellectual activities, practically complete absence of the influence of negative factors of conventional treatment (pains, dyspepsial, cosmetic defects) higher appreciation of their health conditions, well being, which manifests in higher quality of life in operated patients.

[Pre- and postoperative ultrasonic study in gunshot wounds of parenchymal organs]. / Do- i posleoperatsionnoe ul'trazvukovoe issledovanie pri ognestrel'nykh raneniiakh parenkhimatoznykh organov.

Timely discovery of the bullet or its fragments in the human body and determination of the character and size of the damage inflicted to the internal organs guarantee adequate treatment of the injured. USE makes it possible to exclude or recognize injury to the parenchymal organs (subscapular and intra-tissue hematomas, complete crushing of the organ), and to reveal free or bounded fluid in the abdominal and pleural cavities and in the retroperitoneal space. Moreover, USE may be applied for identifying the location of the bullet or fragment in he parenchymal organ, the subcutaneous fat or the retroperitoneal fat. Intraoperative USE proves to be of great aid in many cases because it allows complete examination of the structure of the internal organs and the abdominal spaces in all planes and the condition of the retroperitoneal fat. The article describes cases in which USE helped in precise localization of the bullet and in revealing the character of the damage, as the result of which an optimal plan of surgical intervention was chosen.

[Connection of polymorphic alleles of the gene cluster AI/CIII/AIV with disturbed lipid metabolism]. / Sviaz' polimorfnykh allelei gennogo klastera AI/CIII/AIV s narusheniiami lipidnogo obmena.

The study of polymorphisms of human apolipoprotein AI/CIII/IV gene cluster in the Moscow population was carried out using of methods of polymerase chain reaction and restriction. Polymorphisms of apolipoprotein AI/CIII/AIV gene cluster detected with SacI, PstI, PvuII, MspI have been investigated to search for their possible relation to the following quantitative lipid parameters: total cholesterol, HDL cholesterol, triglycerides, apolipoproteins AI, apolipoproteins B. It has been determined that in groups of individuals with increased cholesterol level the frequencies of uncommon alleles at the MspI, SacI, PvuII sites were significantly higher than in controls. Our results show that in groups with increased triglyceride level the frequency of uncommon alleles at the MspI and SacI sites was higher than in controls. Individuals with elevated apolipoprotein B and ratio of apolipoproteins B/AI > 1 have significantly higher frequency of uncommon alleles at the SacI and PvuII sites and uncommon alleles at the PvuII site, respectively. There was no statistically significant correlation between polymorphism at PstI site and lipid level variation. It has been established, by constructing DNA haplotypes, that the presence of particular haplotypes containing an uncommon allele at the PvuII and SacI sites, PvuII and MspI sites, MspI and SacI sites, PvuII and PstI sites, SacI and PstI sites is associated with lipid disorders, and may be associated with development of atherosclerosis.

[Determination of the reactive luminol-dependent chemiluminescence of neutrophils]. / Opredelenie reaktivnoi liuminolzavisimoi khemiliuminestsentsii neitrofilov.

Reactive luminol-dependent neutrophilic chemiluminescence was estimated in 25 children aged 4 to 14. No essential differences in spontaneous and induced chemiluminescence of venous and capillary blood samples diluted 1:100 were detected. Therefore both methods may be used.

[Various properties of DNA from isolated fractions of the mouse synaptonemal complexes]. / Nekotorye svoistva DNK iz vydelennoi fraktsii sinaptonemnykh kompleksov myshei.

A fraction of synaptonemal complexes (SC) isolated from mouse spermatocytes has been electrophoretically purified in agarose gel. The DNA from the SC fraction constitutes approximately 0.5% of total nuclear DNA, and its molecules have length heterogeneity from 1 k.b. to 20 k.b. The content of beta-globin gene is the same in DNA from the SC fraction and in total nuclear DNA. The specificity of DNA from the SC fraction is manifested by higher contents of the repeated alternative sequences GT/CA and B1-sequence that is probably due to the processes of genetic meiotic recombination.

[Loss and stabilization of aminopterin resistance in murine cell lines]. / Poteria i stabilizatsiia ustoichivosti k aminopterinu v kletochnykh liniiakh myshi.

Mouse L-cell lines (B-82, tk-) were obtained using the stepwise selection method, their aminopterin (AP) resistance being 10(3)-5 X 10(4) times higher than that of parental cells. This resistance increase results from dihydrofolate reductase (DHFR) gene amplification which was determined from the 15-120-fold rise of the enzyme activity and with the cytogenetical techniques. The development and loss of AP resistance have been studied and karyological analysis of the lines obtained carried out. Two types of karyological changes were found in stable DM and HSR cells which correspond to extrachromosomal and intrachromosomal forms of the amplified material organization. Localization of the DHFR gene in HSR was proved using the in situ hybridization technique. Extrachromosomal localization of the amplified genes in DM providing unstable AP resistance is dominant at the early stages of the development of resistance and for a long time. It was demonstrated that DM and HSR can exist in one cell during the prolonged period. DHFR gene copy number in such cells is regulated by a change in the DM number, whereas the HSR size and localization are highly stable. HSR covers 1.7-1.9% of the genome length and 38-40% of the marker chromosome length. The genes localized in HSR provide stable AP resistance. Evidence on some intermediate, relative stabilization of the resistance has been obtained. This stabilization is mediated by temporary integration of DHFR copies into other chromosomal sites, in addition to HSR.

[Biochemical and ultrastructural analyses of the synaptonemal complex in mammalian spermatocytes]. / Biokhimicheskii i ul'trastrukturnyi analizy sinaptonemnogo kompleksa v spermatotsitakh mlekopitaiushchikh.

In order to study the molecular organization of synaptonemal complex (SC), a preparative method for isolation of relatively purified SC from rat, mouse and hamster testes was elaborated which involves isolation of SC-containing (pachytene) nuclei, their lysis, DNAase digestion of DNA and fractionation of nuclear elements by the discontinuous sucrose density gradient centrifugation. Electron microscopy revealed a rather good preservation of the SC structure after the isolation procedure. Effects of the dissociating agents on the SC structural integrity were studied. It has been demonstrated that the treatment with 2M NaCl, Triton X-100, sodium deoxycholate, 6M urea, and with a buffer containing 2% SDS and 5% mercaptoetthanol does not lead to a complete SC dissociation, though it results in some structural chanes. Possible reasons of the high resistance of SC to dissociating treatment are discussed.

[Distribution of spontaneous and 8-methoxypsoralen-induced sister chromatid exchanges along the length of the 1st chromosome of Chinese hamster cells]. / Raspredelenie spontannykh i indutsirovannykh 8-metoksipsoralenom sestrinskikh khromatidnykh obmenov po dline pervoi khromosomy kletok kitaiskogo khomiachka.

Distributions of spontaneous, induced by monoadducts and induced by crosslinks sister chromatid exchanges (SCE) along the first chromosome of Chinese hamster cells are nonrandom. All experimental distributions have low frequency of SCE in centromeric and telomeric regions. It can be explained by specific structural organization of the chromosome. However, there are some differences between experimental distributions. Distribution of SCE induced by crosslinks differs from that of spontaneous SCE. Distribution of SCE induced by monoadducts, unlike other distributions, has an increased frequency of exchanges in the q11 region. This region contains several narrow closely disposed G+ bands. It is possible that monoadducts lead to increasing SCE frequency on G+-G- junctions. Distribution of SCE induced by crosslinks resembles random distribution, except centromeric and telomeric regions. These results lead to conclusion that the mechanisms of formation of spontaneous, induced by monoadducts and induced by crosslinks SCE differ from each other.