Combined surgical treatment of giant cavernous hepatic hemangioma: A case report.

INTRODUCTION AND IMPORTANCE: Hepatic hemangiomas are the most common benign liver tumors, which in most cases are small in size and do not require specific treatment. Giant hepatic hemangiomas are a rare pathology. The purpose of this report is to demonstrate the case of combined treatment of giant hepatic hemangioma. CASE PRESENTATION: A man of the Caucasian race, 37 years old, appealed to the clinic with a complaint about the presence of palpable abdominal mass. During the examination a giant cavernous hemangioma of the left lobe of the liver with a vertical size of up to 210 mm was discovered. Endovascular transarterial embolization (ETE) of tumor-feeding hepatic artery followed by radical surgery on mass removal is performed. CLINICAL DISCUSSION: Giant hemangiomas often cause compression of nearby structures and cause symptoms such as pain, abdominal discomfort, nausea, early food saturation, etc. Cases of spontaneous rupture of cavernous hemangioma, including fatal outcome, are also described. We suggest that some patients should go through surgical treatment even if they do not have any complaint. CONCLUSIONS: Our experience shows that endovascular embolization of the hepatic arteries can be effectively applied as a pre-surgical preparation method in order to reduce hemangioma size and blood loss volume during surgical intervention.

[Improving renal cancer care].

The article reviews the rates of incidence, late diagnosis and mortality from kidney cancer in Primorsky Krai. The authors address the issues of improving primary and specialized medical care by introducing a three-level health care system and restructuring of hospital beds. They propose a new medical technology for assessing the individual risk of kidney cancer and present a program of measures and organizational modules for prevention, early diagnosis and reduction of mortality from kidney cancer.

[Treatment tactics of hemorroidal disease stage III-IV].

The Miligan-Morgan's operation has long been considered to be the "golden standard" of hemorrhoids' stage I-III treatment. The invention of distal branches of the upper rectal artery' suture ligation with mucopexia and lifting of the anal canal mucosa discovered new possibilities for hemorrhoids surgery, though there are still some questions considering long-term results. 151 cases of recurrence within 1-6 months were analyzed. The use of CT-angiography with 3D reconstruction of the upper rectal artery allowed to chose the operative technique more relevant and thus improve the treatment results.

[Relaparascopy in the treatment of postoperative complications].

Videoendoscopic technologies were used in the treatment of postoperative complications in 289 patients. All repeated laparoscopic procedures in early postoperative period after laparoscopic and laparotomic surgeries are integrated under the term "relaparoscopy". The algorithm of choice of a surgical method during laparoscopic examination is presented, technical principles of laparoscopic surgeries, indications and contraindications are formulated. Postoperative peritonitis was diagnosed in 66 (22.7%) patients, abdominal abscesses -- in 64 (22.1%), early intestinal obstruction -- in 58 (20.1%), bile outflow -- in 53 (18.2%), postoperative bleedings -- in 26 (9.1%), local liquid accumulations -- in 17 (5.8%), abdominal foreign bodies --- in 5 (1.9%) patients. Relaparoscopy was a final method of treatment of postoperative complications in 74.5% patients. In 8.6% patients videoendoscopic procedures permitted performing some elements of surgery and to convert to minilaparotomy. In 16.9% patients indications for relaparotomy were revealed during relaparoscopy, after which dynamic relaparoscopy was used as programmed sanations.