[Combination of toxic multinodular goiter and primary hyperparathyroidism with rare ectopia of parathyroma]. / Sochetanie mnogouzlovogo toksicheskogo zoba i pervichnogo giperparatireoza s redkoi éktopiei paratireomy.

A well-known feature of primary hyperparathyroidism (PHPT) is possible ectopic localization of parathyroid adenoma that can significantly complicate diagnostic process. Ectopia in the aortic window is extremely rare and accounts only 1% of ectopic parathyroid adenomas in the mediastinum and 0.24% among all parathyroid adenomas. Combination of multinodular toxic goiter and primary hyperparathyroidism with a rare variant of ectopia makes this observation very valuable from scientific and practical point of view.

[Current approach to the diagnosis and treatment of primary hyperparathyroidism]. / Sovremennyi podkhod k diagnostike i lecheniiu pervichnogo giperparatireoza.

AIM: To optimize diagnosis and surgical treatment of patients with primary hyperparathyroidism. MATERIAL AND METHODS: Retrospective comparative analysis of diagnosis and surgical treatment included 444 patients who were treated at the specialized department of endocrine surgery of Pirogov National Medical Surgical Center in 2012-2017. Archival materials and electronic databases of the clinic were applied. RESULTS: It was developed the algorithm which may be used in most patients for minimally invasive parathyroidectomy. Minimally invasive surgery reduces the risk of complications and is associated with reliable efficacy and good cosmetic effect.

Risk factors and prognosis of voice disorders after surgical treatment of thyroid and parathyroid diseases. / Faktory riska i prognozirovanie narushenii golosa posle khirurgicheskogo lecheniia zabolevanii shchitovidnoi i okoloshchitovidnykh zhelez.

AIM: To analyze risk factors and prognosis of voice disorders after surgical treatment of thyroid and parathyroid diseases. MATERIAL AND METHODS: There were 1272 patients who were operated in the endocrine surgery department for the period from January 1, 2016 to April 30, 2017. We studied the incidence of VF paresis, VF paralysis, and persistent dysphonia as clinical outcomes. Potential risk factors have to be analyzed were sex and age of patients, BMI, diagnosis, surgical technique, thyroid volume, experience of the surgeon and assistant, use of intraoperative neuromonitoring, etc. RESULTS: Significant relationships of risk factors with various complications of thyroid surgery were found. In logistic regression analysis, the independent predictors of complications were the following: 1) for VF paresis - extent of surgery and thyroid volume; 2) for VF paralysis - sex, extent of surgery and thyroid volume; 3) for persistent postoperative dysphonia - age and thyroid volume. CONCLUSION: The correlation of various risk factors with development of VF paresis, VF paralysis and persistent dysphonia were identified in patients undergoing thyroid and parathyroid surgery.

[Preferable surgery for benign tumors of the adrenal glands]. / Vybor metoda khirurgicheskogo lecheniia pri dobrokachestvennykh opukholiakh nadpochechnikov.

AIM: To determine optimal surgical approach in patients with adrenal tumors. MATERIAL AND METHODS: Overall experience of treatment of patients with adrenal tumors comprises over 300 procedures including 152 minimally invasive surgeries. RESULTS: We have presented the advantages and relative disadvantages of various technologies which are useful to be considered to determine the most optimal surgery in these patients. CONCLUSION: There are no serious contradictions to use existing surgical methods in patients with adrenal tumors. Minimally invasive procedures along with conventional (open) interventions significantly enlarged rational choice in surgery for adrenal neoplasms and optimized personified approach.

[Anti-Titin-antibodies at the patients with myasthenic and non-myasthenic thymoma].

Serum specimens from 52 myasthenic patients with thymoma of various histological characteristics and 4 patients with thymoma without myasthenia have tested for anti-Titin-antibodies titer. It has been demonstrated that organ-specific thymoma dominated at myasthenic patients, and organ-nonspecific thymoma - at the patients without myasthenia. There was no correlation between severe clinical symptoms and the level of anti-Titin-antibodies. The titer of antibodies at the patients with organ-specific thymoma was higher that at ones with organ-nonspecific thymoma, but there was no correlation between the level of anti-Titin-antibodies and histological type of organ-specific thymoma.

[Forty-year experience of surgical treatment of generalized myasthenia]. / Sorokaletnii opyt khirurgicheskogo lecheniia generalizovannoi miastenii.

Forty-year experience with surgical treatment of generalized myasthenia (GM) based on 2977 cases is analyzed. Role of special methods of mediastinum examination (CT, MRT) is demonstrated, indications to thymectomy are validated. It is noted that developed diagnostic algorithm, surgical technique, management before and after surgery improved significantly immediate and long-term results. Development of clinical, immunological and morphologic criteria of thymectomy effect permitted to predict course of GM and to optimize complex therapy after surgical treatment.

[Surgical treatment of thymomas in patients with generalized myasthenia gravis]. / Khirurgicheskoe lechenie timom u bol'nykh generalizovannoi miasteniei.

Experience in surgical treatment of 2977 patients with generalized myasthenia is presented, 386 (13%) of them have undergone surgeries for thymus tumors. Organo-specific tumors (thymoma) were diagnosed in 370 (95.9%) of them. Computed and magnetic-resonance tomography has the highest sensitivity and specificity in diagnosis of thymus tumors. Thymomthymectomy was performed in 317 patients including extended one in 117 (36.9%). Postoperative lethality in thymic tumor in the last years was 0.5%, general lethality over all period--5.1%. According to used classification (WHO, 1999) types of thymoma were the following: type A--2.1%, type B--86.3%, type AB--9.6%. Prognosis of surgical treatment depends of tumor type (it is worse in type B than in types A and AB), duration of the disease and severity of myasthenia.

[Tumors of the thymus]. / Opukholi vilochkovoi zhelezy.

Tumours of the thymus include heterogenic group of benign and malignant organ-specific (thymomas and carcinoma) and organ-nonspecific (neuroendocrine, germinogenic tumours, lymphomas and others) neoplasms. Histologic classifications are now the most useful for the correlation with prognosis and clinical manifestations. It is obligatory to do verification of the progression stage.