[Diagnosis and surgical treatment of arterial hypertension of adrenal origin]. / Diagnostika i khirurgicheskoe lechenie arterial'nykh gipertenzii nadpochechnikovogo geneza.

230 patients with arterial hypertension of adrenal origin were treated. 205 of them underwent adrenalectomy with surrounding paranephral fat. There were no lethal outcomes. Endogenic adrenocorticism was diagnosed in 134 patients. Cushing's syndrom was in 96 patients, Cushing's disease--in 34, ACTH-ectopic syndrome--in 2, adrenocortical cancer--in 2. Primary hyperaldosteronism was diagnosed in 42 cases: idiopathic hyperaldosteronism in 23 patients, aldosteronproducing adenoma (Conn's syndrome)--in 19. Tumors of chromaffine tissue were defected in 30 patients. All the patients underwent complex examination (hormonal profile, US, CT, MRT, angiography if it was necessary). Symptomatic arterial hypertension of adrenal origin was diagnosed during one year in 10% patients only because of absence of typical clinical picture. Use of complex examination has permitted to make a correct topical diagnosis and to choose optimum treatment policy in all the cases.

[Treatment of hydatid echinococcosis]. / Lechenie gitatidnogo ékhinokokkoza.

In Russia the first one-stage operation for hepatic echinococcosis was performed by A.A. Bobrov by his method in 1895. At present there is much experience in surgical treating echinococcosis. With the advent of new ultrasonic diagnostic methods, computed tomography, and new germicide treatment methods have changed. The analysis of 228 patients with echinococcosis treated from 1983 to 1999 was carried out. The traditional surgical interventions were performed in 121 patients; the mortality was 2.5%, the relapse rate 22.3%. Minimum invasive interventions (punctures, hydatid cyst drainage, followed by germicidal treatment) were performed as the only treatment in 68 patients and with subsequent traditional interventions in 22 patients. Experimental studies demonstrated that the retention of gigantic acephalocysts in traditional treatment is the main cause of echinococcal dissemination. 80-100% Glycerin is the most effective germicide. Chemotherapy as the only treatment may be applied only in very minor cysts inaccessible to puncture. A combination of minimum invasive procedures and preoperative (1 course) and postoperative (2-3 courses) chemotherapy is the most effective.

[Intraoperative ultrasonography in surgery on organs of abdominal cavity and retroperitoneal space]. / Intraoperatsionnoe ul'trazvukovoe issledovanie organov briushnoi polosti i zabriushinnogo prostranstva.

Since 1984 to 1999 intraoperative US examination (IOUSE) was made in 863 patients. 236 of them had diseases of the liver, 137 diseases of the gall bladder and biliary tract, 158 pancreatic disorders, 151 diseases of gastro-intestinal tract, 72 diseases of the adrenal glands, 101 constitutional obesity, 3 splenic disorders and 5 gunshot wounds of the organs of the abdominal cavity and the retroperitoneal soft tissues. In masses of the liver IOUSE showed limits for resection of the liver, location of the diseased area with the vessels and biliary ducts, unpalpablefoci. OUSE allowed to perform US-guided puncture and sclerosizing small metastatic nodes as well as a puncture and antiparasitic treatment of inaccessible echinococcal cysts. In cholelithiasis IOUSE allows to reveal or to rule out the presence of the concrements in bile ducts. In cases of diseases of the pancreas IOUSE helps to localize pathologic area, defines its interrelations with adjacent major vessels and ducts, reveals unpalpable masses and enables US-guided puncture of the major pancreatic duct followed by its further opening. In gastric tumors it is possible under US control to determine precisely the limits of the infiltration of gastric wall which defines the volume for resection. In operation on the adrenals from thoracophrenolumbar approach IOUSE through the diaphragmatic cupula determines the place and the length of phrenotomy and elucidates interrelations of the tumor with adjacent organs. Sensibility of IOUSE made up from 87 to 100%, and specificity--92-100% depending on the disease.

[Adrenal tumors found by chance. Surgical treatment or follow-up?]. / Sluchaino vyiavlennye opukholi nadpochechnikov. Khirurgicheskoe lechenie ili dinamicheskoe nabliudenie?.

206 case records of the patients treated from 1985 to 1998 for various diseases of the adrenal glands were analyzed. In 39 (18.9%) patients tumors were chance finding at ultrasound examination or computer tomography of the abdominal cavity and retroabdominal space. 25 patients from this group were operated on, 14 patients were not operated and were followed up from 1 month to 7 years. All the patients underwent complex examination including analysis of the complaints, anamnesis and physical examination data, hormonal status examination (ACTH, hydrocortisone, 11-oxycorticosteroids, 17-ketosteroids, aldosterone, renin, adrenalin, noradrenalin, vanillyl-mandelic acid), device methods of examination USE, CT, MRT, superselective phlebography with separate catheterization of adrenal veins and blood intake per floor, fine needle aspiration biopsy under ultrasound control. Comparison of the results of complex clinical examination with morphological data of removed adrenal glands was carried out retrospectively. Arteriography and superselective phlebography with separate catheterization of adrenal veins and per floor taking of blood samples, performed in 36 patients, enabled not only to supplement and define more exactly the other methods of topical diagnosis, but also to asses objectively functional actively of the affected and contralateral adrenal. Despite the fact that during the study of hormonal level in peripheral blood of patients it was normal analysis of the data obtained by superselective phlebography of adrenal veins and per floor taking of blood samples showed significant increase in hormones level in blood of all operated patients. Comparison of the data of superselective phlebography with separate catheterization of adrenal veins and per floor taking of blood samples and clinical picture of the disease made it possible to suggest the presence of preclinical (subclinical) Cushing or Conn syndrome. Operative treatment was not indicated in the absence of hormonal activity of the tumor (i.e. preclinical syndromes by Icenko-Cushing, Conn, pheochromocytoma, the virilizing and feminizing tumors), tumors of small size (less than 3 cm), in absence of malignant growth features confirmed by complex instrumental examination (USE, CT, MRT, fine-needle aspiration biopsy under US control, superselective phlebography with per floor taking of blood samples). Such patients were reexamined in 6 months. During the follow up period no changes of tumor size, homogeneity, hormonal status were revealed.

[Diagnosis and treatment of isolated subdiaphragmatic liquid accumulations under ultrasound control]. / Diagnostika i lechenie ogranichennykh poddiafragmal'nykh zhidkostnykh skoplenii pod kontrolem UZI.

The analysis of diagnostic abilities of ultrasound and miniinvasive treatment under ultrasound examination control in 39 patients with subdiaphragmatic local fluid accumulations in abdominal cavity has been carried out. The revealed by US examination manifestations of the abscess formation in 15 patients, local noninfected accumulation of fluid in 20 patients, haematomas (hemolized)--in 4 are described. Indications for the treatment by punctures and drainage of local subdiaphragmatic fluid accumulations under US control depending on the size, form and character of liquid accumulation are given. 11 patients were cured by a single puncture, 1--by multiple punctures, 27--by drainage under US-control. The use of miniinvasive technologies resulted in no complications and mortality in this group of patients. Laboratory examination of the material taken by punctures and drainage under US-control demonstrated in 20 patients infected material and in 14--uninfected one, in 5 patients hematoma was detected. Standard operations performed from 1946 in the surgical clinic resulted in lethality of 19%.

[Minimally invasive interventions in treatment of mechanical jaundice]. / Maloinvazivnye vmeshatel'stva v lechenii mekhanicheskoi zheltukhi.

For the period from 1972 to 1997 676 transcutaneous transhepatic and 370 endoscopical interventions in 953 patients with mechanical jaundice were carried out. In 58.5% of cases jaundice was caused by malignancies, in 41.4%--by benign strictures of bile ducts. 40 external biliary bypasses, 427 external-internal biliary bypasses, 55 cholecystostomies and 154 operations of biliary endoprosthetic reconstructions were conducted under US control and TV imaging. In 33.5% of cases biliary bypass and endoscopical procedures were made as a preliminary stage of preparation of patients for operation or as a final method of treatment after conventional operation procedures, in 66.5% of cases it was final method of treatment. There were no deaths caused by biliary bypass procedures nor complications related to laparotomy. Thus low invasive interventions, undoubtedly, are the method of choice in mechanical jaundice for preparation of patients before radical operations as well as for relief of the course of disease in patients with inoperable cancer which causes obstruction of biliary ducts.

[Thymomas with a myasthenic syndrome]. / Timomy s miastenicheskim sindromom.

2560 patients with generalized myasthenia (Gm) were operated during 1960-1996. Tumors of the thymus (TT) which are the most often neoplastic masses of anterior mediastinum were revealed in 312 patients. Among them organ-specific tumors (thymomas, cancers) were detected in 252 patients (95.8%). Comparative analysis of effectiveness of a number of special methods of diagnostics of TT showed that CT and magnetic resonance tomography are the most sensitive and specific methods. Thymoma-thymectomy was carried out in 247 patients, among them in 93 (37.7%)--extended one. Postoperative lethality made up 5.1%, last years (1990-1996) there were no fatal outcomes. Among early postoperative complications wound infection was observed in 2.5% of patients, pneumonia--in 1.3%, myasthenic crisis--in 1.6%. Basing on histogenetic classification, following kinds of thymomas were singled out: in 58.9% cortical ("light cellular"), in 2.2%--medullar ("dark cellular") and in 38.9%--mixed cellular thymomas. Long-term results of thymectomy in patients with Gm in various kinds of thymomas were different: at the 5th year of follow-up they are worse in cortical cellular types and much better in medullar--cellular and mixed cellular thymomas with prevalence of medullar component.

[The functional results of distal subtotal gastric resections in cancer patients]. / Funktsional'nye rezul'taty distal'nykh subtotal'nykh rezektsii zheludka u bol'nykh rakom.

It was clinically proven that a gastrojejunostomy with Rue-type anastomosis, following the subtotal gastric resection has better functional results. This method does not cause as many late postoperative disorders as Billroth I and Billroth II operations. So, it is better to use the Rue-type anastomosis for treatment of distal stomach cancer stage I-III.

[Diagnosis, surgical treatment and prognosis in endocrine hypertension of adrenal origin]. / Diagnostika, khirurgicheskoe lechenie i prognoz pri endokrinnykh gipertoniiakh nadpochechnikovogo geneza.

162 patients with adrenal hypertension have been examined. 48 of them had Cushing's syndrome, 10--aldosteromas, 85 --icenko--Cushing disease. The examination of patients with endocrine hypertension included hormonal background study, computer and MR tomography thin-needle biopsy and made it possible to make valid clinical and topical diagnosis in all cases. Magnetic-resonance tomography appeared to be the most efficient diagnostic method in the syndrome of hypercorticoidism. Ultrasound examination is the most available and highly informative method of revealing hormonally active adrenal tumors when they are more than 1 cm in size. An adequate preoperative preparation equally with an optimal scope of surgery and efficient postoperative substitution hormonal therapy are key factors in treatment of endocrine adrenal hypertension.

[Surgical treatment of children with generalized myasthenia]. / Khirurgicheskoe lechenie detei, bol'nykh generalizovannoi miasteniei.

The rich experience in the country in surgical treatment of children with generalized myasthenia has been analysed. The comparative analysis of various means of preoperative preparation is done. Stabilisation of myasthenical status is very important in the preoperative preparation, the use of steroid hormones is advocated for this purpose. The indications, contraindications, as well as the scope and optimal timing of surgery are formulated. Two types of clinical and immunomorphological changes are depicted in children with generalized myasthenia that are of certain prognostic value. The rating of risk factors, useful for prognosis of unfavorable results of surgery is proposed.

[Choice of treatment of destructive pancreatitis and its complications]. / Vybor metoda lecheniia destruktivnogo pankreatita i ego posledstvii.

Choice of a proper method of treatment of complicated acute pancreatitis remains indefinite. The results of treatment of 130 patients with acute destructive pancreatitis complicated with pancreatic pseudocysts have been analysed. The authors formulate individual indications to minor surgery under the ultrasound control. The classical type of surgery was used only in patients with calculous pancreatitis complicated with pseudocysts (14). In other patients various types of transcutaneous ultrasound controlled procedures were used. Pilot experience of placing cystoduodenoanastomosis under ultrasound endoscopic control is described. Letal outcomes were absent. The rate of recurrence in external drainage was 10, 5%; there were no cases of recurrence in internal drainage of pseudocysts. The period of long-term follow-up was 58 months.

[Thin-needle aspiration biopsy of solitary formations of the thyroid gland]. / Tonkoigol'naia aspiratsionnaia biopsiia solitarnykh obrazovanii shchitovidnoi zhelezy.

The paper analyzes the use of thin-needle aspiration biopsy in 372 patients with thyroid solitary formations. By the results of clinical and instrumental studies and cytological examination of thyroid puncture specimens groups of patients with individual clinical and morphological types of the disease were identified. Differential surgical policy in each group of patients was shown on the basis of the finding. It is concluded that thin-needle aspiration biopsy should be integrated into the compulsory programme of comprehensive examination of patients with thyroid solitary formations. Having a high efficiency, the above method helps in most cases to make an accurate clinical and morphological diagnosis and to choose the optimal treatment policy for each specific patient admitted to a surgical hospital for an aggregate diagnosis of nodal euthyroid goiter. Some patients may avoid unjustifiable surgical intervention and be on conservative therapy under follow-up.

[Informative value of various diagnostic methods in Itsenko-Cushing syndrome]. / Informativnost razlichnykh diagnosticheskikh metodov pri sindrome Itsenko-Kushinga.

The authors discuss the comparative evaluation of different methods of examination applied in 36 patients with the Icenko-Cushing syndrome. The results of the investigation are compared with the intraoperative findings and the data of morphological studies. MR-topography proved to be mist informative. Ultrasonic examination was highly effective in tumors measuring up to 1 cm in diameter. The use of USE during the operation hor locatind the tumor and determining its connection with the surrounding organs allows the operation to be performed in a shorter time and its traumatic character.

[Ultrasound diagnosis of breast nodules]. / Ultrazvukovaia diagnostika uzlovykh obrazovanii molochnoi zhelezy.

The authors show the comparative data on ultrasonic examination and mammography in 204 patients with nodular new growths in the breast: 66 had breast carcinoma and 138 had benign diseases. They suggest 6 ultrasonic criteria characteristic of breast carcinoma and describe the ultrasonic picture of the most commonly encountered benign breast tumors: fibroadenoma, nodular mastopathy, cysts. USE sensitivity was 68.8 +/- 7% in breast carcinoma, 82.6 +/- 8.1% in fibroadenoma, 72.8 +/- 7.2% in nodular mastopathy, and 100% in cysts (the respective values in mammography were 76.7 +/- 6.4%, 69.6 +/- 9.8%, 74.4 +/- 7%, and 60 +/- 11.2%). USE sensitivity and sensitivity of mammography were found to differ for different age categories in early forms of breast carcinoma. It is shown that the histological structure of a malignant tumor may be assumed from the ultrasonic criteria. The authors conclude that USE has a high diagnostic value in nodular new growths of the breast and that differential diagnosis of malignant and benign lesions is possible.

[Spectroscopic diagnosis of stomach diseases based on laser-induced fluorescence of endogenous porphyrins]. / Spektroskopicheskaia diagnostika zabolevanii zheludka na osnove fliuorestsentsii éndogennykh porfirinov, indutsirovannoi lazerom.

For higher efficacy of early gastric carcinoma diagnosis by endoscopy, the authors suggest a method of autofluorescent diagnostics. It is d=based on the property of endogenous porphyrins contained in the tumor to emit light under the effect of laser. The suggested method was used in examination of 54 patients. The experimental group was composed of 35 patients with gastric carcinoma, the control group was formed of 21 patients with benign diseases gastric ulcer, polyps, chronic gastritis). The sensitivity of the method was 94%, th specificity 90.5%. It is shown that the method of autofluorescent diagnostics may be applied in cases which are difficult for diagnosis.