[Classification of pancreatic exocrine tumours].

Current international histologic classification of exocrine pancreatic tumours is presented. Macro- and microscopic characteristics of benign and malignant tumors are described. The role of immunohistochemistry in differential diagnosis is shown.

[Adult hepatoblastoma].

A rare case of hepatoblastoma is reported in a female of 47 years of age with literature review of these tumors in the adults. Microscopically the tumor was represented by the cells of embryonal and fetal types. Immunohistochemically expression of low-molecular cytokeratins as well as that of S-100 protein and hepatocyte antigen was observed.

Autoradiographic study of parasympathetic paragangliomas (chemodectomas) of the neck.

Study of the morphofunctional characteristics of chemodectomas of the neck by photoautoradiography (semithin sections) showed the absence of protein-producing and proliferative activity in light and dark tumor cells against the background of strained biosynthetic processes in stromal cells. Invasion of capillary walls by tumor cells with their release into the capillary lumen is a prerequisite for metastases of these tumors.

[Electron-radioautographic study of parasympathetic paragangliomas (chemodectomas) of the neck]. / élektronno-radiograficheskoeissledovanie parasimpaticheskikh paragangliom (khemodectom) shei.

Chemodectomas, after the surgery, were studied in 7 patients. Morphologically their malignancy is proven on the basis of pronounced cell polymorphism, atypia, invasion of tumour cells through the vessel wall into their lumen. Besides rare mitoses, proliferative (DNA synthesis) and protein synthetic (RNA synthesis) activity in clear and dark cells was not observed in the presence of intensive biosynthetic processes in the stroma cells.

[Histological variants of parasympathetic paragangliomas (chemodectomas) of the neck and morphological variants of their malignancy]. / Gistologicheskie varianty parasimpaticheskikh paragangliom (khemodektom) shei i morfologicheskie kriterii ikh zlokachestvennosti.

Histotopograms of 28 chemodectomas have been studied. Principal microscopic features of malignancy are as follows: structural atypia (complete in solid or fibrous variants) or partial (alveolar chemodectoma) loss of alveolarity as the most important sign of organotypia; another sign of malignancy is cell cataplasia (cell and nuclear polymorphism, change in nuclear-cytoplasmic relationship in the direction of its increase, nuclear hyperchromatism, appearance of large ungly hyperploid nuclei, mitotic activity of tumour cells in one case. Incomplete angiogenesis characteristic for malignant tumours was also detected. Invasive growth in the majority of chemodectomas in the form of partial growth through the walls of great vessels and ubiquitous growth through the walls of small vessels were present in most chemodectomas. Thus, there is a basis to claim that the chemodectomas studied are malignant tumours although they are characterized by a slow (years) growth and slow progression.

[Surgical treatment of chronic pancreatitis in combination with duodenal ulcer disease]. / Khirurgicheskoe lechenie khronicheskogo pankreatita v sochetanii s iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Results of two surgeries--total and subtotal resection of pancreatic head in combination with selective proximal vagotomy (SPV)--performed for chronic pancreatitis and duodenal ulcer disease (DUD) are presented. In one case surgery was supplemented with circular resection of the duodenum and fundoplication. Reconstructive stage of both surgeries included creation of pacreato- and biliodigestive anastomosis on Roux intestinal loop. Choledochojejunoanastomosis was created on the same loop of the small intestine either "end-to-side" with supraduodenal part of common bile duct or "side-to-side" with its pancreatic part. The former surgery was finished with duodenoduodenoanastomosis "end-to-end" for recovery of duodenal passage. This surgery was characterized by complete removal of pancreatic head. The latter surgery corresponded to Beger's operation. There were no complications in the nearest postoperative period. Long-term results were favorable and followed up during 17.5 and 7 months, respectively. This experience testifies that resection of pancreatic head with SPV may be considered as alternative to pancreatoduodenal resection in surgical treatment of patients with chronic pancreatitis.

[Portal embolization (an experimental-morphological study)]. / Portal'naia émbolizatsiia (éksperimental'no-morfologicheskoe issledovanie).

Results of experimental-morphological study of influence of unilobar portal embolization by biologic occlusive material RABROM on the liver of 6 laboratory animals are presented. It is shown that portal venous embolization leads to focal necrosis of parenchyma of embolized hepatic lobe, it atrophy and formation of portal cirrhosis. In non-embolized hepatic lobe the distinct signs of increased regeneration and hypertrophy of hepatocytes were revealed. RABROM didn't lead to damage and inflammatory changes of vascular wall that testifies to it biologic inertia. It is recommended to use the method of portal venous embolization for preparation of patients with low functional hepatic reserve for extensive resections.

[Thermal trauma in a combination with respiratory tract burn]. / Termicheskaia travma v sochetanii s ozhogom dykhatel'nykh putei.

The detection rate of microbial contamination of burn wounds after flame burn was studied in dynamics to 3 weeks in 56 patients forming 2 similar groups: basic--with thermo-inhalation lesions (TIL) and control--without TIL. General area of skin burns in all the patients was less than 50% of the body surface, on average it was 40%, the area of deep burns was 23%. Cytological and bacteriologic methods were used for study microphlora in the sputum and in bronchoalveolar lavage. There were 186 cases of wound microbial contamination (gram-negative microorganisms--64.4% cases, gram-positive--34%, pathogenic fungi--1.6%). In 80% cases the microphlora of the wounds was polymicrobial, in 47% cases the microphlora were detected on the second week. Microphlora was detected 2 times more often in the basic group than in the control, corresponded to skin burn area; the greatest exceeding of critical level of wound contamination was revealed on the first 2 weeks. In TIL besides wound contamination, polymicrobial microphlora revealed in tracheobronchial tree, presented on the first 2 weeks with association of gram-positive and gram-negative microorganisms, combining on week 3 with fungal phlora. Early leukocytosis, not reducing during first 3 weeks of the study, due to intoxication by burn products, occurred in TIL. Early lymphopenia in TIL was the sign of resistant immunodeficiency.

[Recurrent profuse hemorrhage in gastric angiodysplasia]. / Retsidiviruiushchie profuznye krovotecheniia pri angiodisplazii zheludka.

Dieulafoy's disease--i.e. arteriovenous malformation--is a rare cause of gastric bleedings, which makes up 1.5-3% of all sources of hemorrhage. All the armory of diagnostic modalities may require to reveal arteriovenous malformations. Angiography of the stomach appeared to be the most informative method for diagnosis of this disease in 2 patients. Radical treatment of patients with Dieulafoy's disease implies resection of the proximal part of the stomach or gastrectomy. Endoscopic hemostasis (with the use of coagulation and injections of sclerogenous preparations around the diseased area) results in temporary effect.

[Diagnosis and treatment of leiomyosarcomas of inferior vena cava]. / Diagnostika i lechenie leiomiosarkom nizhnei poloi veny.

3 clinical cases and literature data, illustrate effective diagnostic and surgical policy in patients with uncommon type of tumor. Two patients were previously operated in other clinics, but the operations were diagnostic because the tumors were estimated as being inoperable. In all 3 patients radical operations were carried out with resection of infrarenal segment of inferior cava vein without its prosthetic reconstruction. In did not result in substantial blood flow disturbances, because before the operation it was known about the presence of well functioning collaterals. The significance of ultrasound examination, especially duplex scanning, computer tomography and angiography (cavagraphy) is emphasized. Favourable results of treatment, especially conclusion of the tumor resectability are more common in specialized institutions.

[The causative agent of wound infection and sepsis in burn patients]. / Vozbuditel' ranevoi infektsii i sepsisa u obozhzhennykh.

The content of antibodies to the autostrains of bacteria isolated from the wound and blood of burn patients was studied. Antibodies were found not to all species and strains isolated from the wound, but only to 1 or 2 of them. Usually Staphylococcus aureus and Pseudomonas were detected. The appearance or sharp rise of the titer of antibodies even to one of all strains contaminating the wound was observed in all examined burn patients, including those having septic complications, i.e. all these patients retained their capacity of antibody formation. The causative agent of wound infection and sepsis, determined by a high titer of antibodies to it, was seldom detected in the blood. This was due to the fact that bacteria were agglutinated by antibodies or retained in tissues on the level of the histo-hematic barrier. In cases of the development of septic endocarditis the inhibiting role of antibodies was not manifested, and the causative agent of this infection was often detected in the blood.

[Computerized tomography characteristics of angiodysplasia with angiomatosis of the soft tissues]. / Kompiuterno-tomograficheskaia kharakteristika angiodisplazii s angiomatozom v miagkikh tkaniakh.

CT findings and the data of morphologic analysis of angiodysplasias were correlated to the clinical data in 130 CT examinations of 115 patients (59 male and 56 female) aged 17 to 53.4 of whom were previously operated on without success. Three patients suffered from arteriovenous fistulae, the rest from angiomatosis of various sites, involving soft tissues of the head, neck, trunk, upper and lower limbs. Control examinations were carried out in 15 patients, in 11 cases contrast amplification of the image was carried out. Histologic studies were carried out in 87 patients. The study has demonstrated the CT diagnostic potentialities in angiodysplasias with soft tissue angiomatosis without resorting to contrast amplification of the image. Three variants of CT signs of muscle angiomatosis were distinguished, that were confirmed by morphologic data. Angiodysplasia manifestations were studied in the patients previously operated on, as were the CT potentialities in examinations of the patients in the postoperative period.

[The morphological characteristics of the fibromyalgia syndrome]. / Morfologicheskaia kharakteristika sindroma fibromialgii.

A histological and ultrastructural study of dense foci characteristics for soft tissues in fibromyalgia syndrome revealed that they consist of rough fibrillar connective tissue frequently hyalinized. Vascularization occurred at the periphery of these foci only where thin nervous fibrils and sometimes small paraganglia were seen. Severe degenerative changes of the collagen fibers, marked decrease and degeneration of fibroblasts were found electron microscopically. Signs of inflammation were absent.

[Results of the effect of embolisms, saturated with methotrexate, on intravascular implantation]. / Rezul'taty vozdeistviia émbolov, nasyshchennykh metotreksatom, pri vnutrisosudistoi implantatsii.

The effect of emboli, saturated with methotrexate on the vascular wall and neighbouring tissues of experimental animals is investigated. The creation perspective of the new type of the cytostatics directed transport, promoting the prolonged effect of the preparation is shown.

[The role of a local infectious focus in the development of Pseudomonas aeruginosa sepsis (experimental research)]. / Rol' mestnogo infektsionnogo ochaga v razvitii sinegnoinogo sepsisa (éksperimental'noe issledovanie).

The dynamics of sepsis development and the formation of metastatic foci have been studied using an experimental model. It has been established, that at the initial stages, the process manifests itself by bacteremia and endotoxemic shock, as well as by the complex of vascular disorders. The dependence of the formation of metastatic abscesses on the terms of the primary focus excision as well as the irreversibility of sepsis at the definite stage of infectious process have been studied. It is supposed, that the primary focus initiates the cascade activation mechanism of the factors, that determine the transition of bacteremia to the stage of septicopyemia.

[Experimental bases of directed transport of antibiotics in suppurative-inflammatory diseases of the liver and biliary tract]. / Eksperimental'noe obosnovanie napravlennogo transporta antibiotikov pri gnoino-vospalitel'nykh zabolevaniiakh pecheni i zhelchnykh putei.

The possibility of use and effectiveness of directed transport of antibiotics in erythrocyte carriers in the treatment of suppurative-inflammatory diseases of biliary ducts has been studied on dogs. It has been found that erythrocyte carriers were resistant to desorption of antibiotics in the blood circulation. Pharmacokinetic investigation has shown the more prolonged collection of antibiotics in hepatic tissue in comparison with traditional intravenous route. The results of clinical, pharmacokinetic and morphological investigation have shown more effectiveness of directed transport of antibiotics to the liver in autologous erythrocyte carriers in treatment of suppurative diseases of biliary ducts in comparison with traditional methods of infusion of antibiotics. For reasons given it is recommended to use this method in clinical practice.

[Significance of characteristics of microorganisms in the pathogenesis B. pyocyaneus infection (an experimental study)]. / Znachenie osobennostei mikroorganizmov v patogeneze sinegnoinogo sepsisa (éksperimental'noe issledovanie).

The experimental Pseudomonas Sepsis was induced by various strains. Biological features of these strains were different and various forms of sepsis were induced. The authors suggested that biological features of microorganisms cause the development of different and various forms of sepsis.