Serum interleukin-6 in patients with adrenal tumors.

The mean blood content of interleukin-6 in patients with adrenal tumors was much higher than in healthy donors. No correlations were revealed between interleukin-6 level, patients sex and age, stage and duration of the disease. Interleukin-6 concentration was maximum in patients with adrenocortical cancer. A negative correlation was found between interleukin-6 level and blood cortisol concentration in patients with cortisol-producing adenoma. In patients with aldosterone-producing adenoma, interleukin-6 level tended to correlate negatively with plasma renin activity.

[Ultrastructural criteria of clinical prognosis in hormonally non-active adrenocortical tumors]. / Ul'trastrukturnye kriterii klinicheskogo prognoza pri gormonal'no-neaktivnykh adrenokortikal'nykh opukholiakh nadpochechnikov.

The investigation was concerned with histological and ultrastructural features of adrenocortical tumors of the adrenals, which have a differential-diagnostic and clinico-prognostic relevance. Histological and electron-microscopical examination of 60 tumors (adrenocortical adenoma--12; adrenocortical cancer--48) was carried out and the findings were compared with clinical data. No significant correlation between histological pattern of adrenocortical tumors and survival was established. Ultrastructural evidence showed electron-microscopical examination to be a reliable procedure for making prognosis of adrenocortical cancers. There was a direct correlation between the level of differentiated cells and degree of their differentiation, on the one hand, and the quality of prognosis and survival, on the other. The significant predominance of differentiated cells was characteristic of adrenocortical adenomas.

Ultrastructural criteria of malignancy of adrenal medullary tumor.

Histological analysis and electron microscopy of 12 benign pheochromocytomas and 9 malignant pheochromoblastomas showed that there are no reliable histological differences between cells of benign and malignant tumor of the adrenal medulla. The ratio of ultrastructurally differentiated and undifferentiated cells in the tumor can reflect their maturity; the more ultrastructurally undifferentiated and less differentiated cells in the tumor, the higher is the malignant potential of this tumor.

[Kidney cancer metastasis to the adrenal gland. Role of adrenalectomy]. / Metastazy raka pochki v nadpochechnike. Rol' adrenaléktomii.

We analysed case records of 2507 patients with renal cell carcinoma treated in the department of onco-urology of Cancer Research Center (Moscow). 1939 of them underwent nephrectomy between 1971 and 1999. The overall incidence of adrenal metastases according to CT and histological findings was 4.7%. Synchronous metastases occurred in 90 and metachronous ones in 30 patients. Radical nephrectomy with adrenalectomy was performed in 18 out of 90 patients with synchronous metastases, palliative nephrectomy in 20 and 52 patients were not considered for surgery. Among 18 patients who underwent complete surgical resection, 12(66%) had either lymph node involvement or distant metastases. A microscopic metastasis was found on histological examination only in 1 patient with normal CT scan and macroscopically intact adrenal on intraoperative assessment. Mean survival after radical nephrectomy with adrenalectomy in 6 patients with solitary lesions was 57 months compared to the longest survival of 31 months in patients with widespread disease. Solitary metachronous ipsilateral and contralateral adrenal involvement was present in 7 patients. The average interval between nephrectomy and appearance of adrenal metastasis in this group was 73 months. One patient was lost for follow-up and one died of adrenal deficiency 4.3 months after adrenalectomy. One patient underwent a consecutive removal of brain and lung metastases 33 and 38 months following adrenalectomy while the remaining 4 were alive in 15, 16, 26 and 34 months with no evidence of the disease. Thus, ipsilateral adrenalectomy is obligatory only in patients with severe disease as shown by CT scan or at nephrectomy. About one-third of the patients will benefit from the surgery. Adrenalectomy should be performed in case of obvious adrenal involvement. The aggressive surgical approach is justified in solitary metachronous adrenal involvement because of long-term survival expected in some of such patients.

[Expression of argyrophilic proteins from the nucleolar organizer regions as an index of maturity degree of benign and malignant adrenal tumors]. / Ekspressiia argirofil'nykh belkov oblastei iadryshkovogo organizatora kak pokazatel' stepeni zrelosti dobrokachestvennykh i zlokachestvennykh opukholei nadpochechnika.

Expression of APNOR was studied in 26 benign and malignant tumors of adrenal cortex and medulla. The histochemical method with silver nitrate was used. Expression of APNOR argyrophilic proteins in adrenocortical carcinomas was 4.59 times higher than in adrenocortical adenomas and 2.63 times higher in pheochromoblastomas than in pheochromocytomas. This index may be recommended as an additional method for differential diagnosis of benign and malignant adrenal tumors, particularly in difficult border line cases as well as determination of prognosis and metastatic potential of these tumors. Cytospecificity of APNOR expression in different types of adrenal cells was established.

[Immunohistochemical identification of hormonally-inactive tumors of the adrenal gland]. / Immunogistokhimicheskaia identifikatsiia gormonal'no-ne-aktivnykh opukholei nadpochechnika.

An immunohistochemical study was carried out to differentiate between such neoplasms of the cortical and cerebral layers of the adrenal as adrenocortical tumor and pheochromocytoma. It used antibodies to chromogranin A, synaptophysin, vimentin, cytokeratin 8, pancytokeratin, carcinoembryonic antigen, epithelial membrane antigen, neurofilaments, alpha-fetoprotein, alpha-antitripsin and neuron-specific enolase. Chromogranin A and synaptophysin appeared to be immunohistochemical markers for pheochromocytoma since it responded negatively to vimentin and cytokeratin. Adenocortical tumors were associated with positive reaction to vimentin and a negative one to cytokeratin. These characteristics were used to differentiate adrenocortical tumors from adenomas which responded to cytokeratin and hardly to vimentin. A possibility of adrenal tumors consisting of endocrine and neurogenic cells is considered.

Soluble Fas antigen (sFAS) in the serum from patients with adrenal tumors.

Serum content of soluble Fas antigen was measured by enzyme immunoassay in 60 healthy donors, 31 patients with adrenal tumors, and 16 patients with diffuse-and-nodular hyperplasia of the adrenal cortex accompanying primary aldosteronism and Cushing's disease. sFas was more often detected in the serum from patients with tumors of the adrenal cortex and medulla and diffuse-and-nodular hyperplasia of the adrenal cortex and its content varied in a wider range in patients compared to healthy donors. No correlations were found between the incidence of sFas, its content, sex, and age of healthy donors and patients. The highest content of sFas was found in patients with pheochromocytoma and primary aldosteronism. sFas probably plays a role in the pathogenesis of adrenal tumors and hyperplasia.

[Results of the treatment of pseudarthrosis of the tibia by subsurface and extrafocal osteosynthesis]. / Rezul'taty lecheniia psevdoartrozov bol'shebertsovoi kosti pri pogruzhnom i vneochagovom osteosinteze.

The results of treatment of 417 patients with pseudoarthroses of the tibia (aged from 17 to 71 years) with the use of various methods: by internal fixation with auto- and allografts, metal plates as well as in the use of extranidal (extralocal) osteosynthesis were analysed. The number of consolidation failures was minimal after autoplasty by Khakhutov and bone autoplasty. The rate of healing after osteosynthesis was substantially lower in internal fixation, than in extranidal (extralocal) osteosynthesis. Inflammatory complications occur less frequently when osteoplasty by Khakhutov was used. The highest rate of complications was observed in tibialization and in bilocal osteosynthesis.

[The causes for the worsening of treatment results in patients with infected pseudarthroses of the tibia in recent years]. / Prichiny ukhudsheniia rezul'tatov lecheniia bol'nykh s infitsirovannymi psevdoartrozami bol'shebertsovoi kosti v poslednie gody.

Under analysis were results of treatment of 141 patients with infected pseudoarthroses of the tibia. Among them there were 10 women and 131 men aged from 18 to 62 years. The long-term results were followed-up during the period from 2 to 20 years. The analysis allowed a supposition that a combination of tibia segment resection and plasty with local tissues completed by suturing the wound, drainage and external fixation with the Ilizarov device leads to deterioration of the outcomes. A careful approach to treatment of such patients including the division of treatment into the stages of debridement and reconstruction seems to be more productive.

[Current principles of diagnosis and surgical treatment of non-organ retroperitoneal tumors]. / Sovremennye printsipy diagnostiki i khirurgicheskogo lecheniia neorgannykh zabriushinnykh opukholei.

The data on surgical treatment of 455 patients operated on for primary and recurrent non-organ retroperitoneal tumors (NRT) are discussed. 64.2% of tumors were resected; postoperative lethality was 8.2%. Particular emphasis is placed on the complex nature of diagnosis and an algorithm of examination is suggested. The sequence of main procedures and stages are described; 43% of radical procedures were performed in combination with one another. NRTs tended to relapse and malignant tumors recurred most frequently within the first 18 months. In the course of 182 operations, 54.4% of NRTs were resected: postoperative lethality was 11.1%. The end results were determined by a number of factors, primarily, nature of tumor (benign or malignant), tumor process (primary or recurrent), tumor size and histological pattern. Because of the poor end results, surgical procedures should be improved and their range should be extended.

[Surgical treatment of adrenal gland tumors]. / K voprosu o khirurgicheskom lechenii opukholei nadpochechnikov.

The data on surgical treatment of 146 patients with adrenal gland malignancies as well as literature on the problem are discussed.

[Submerged esophago-intestinal anastomosis in surgical treatment of gastric cancer]. / Pogruzhnye pishchevodno-kishechnye anastomozy v khirurgicheskom lechenii raka zheludka.

The short-term results of 1,605 gastrectomies performed for stomach cancer, using different types of esophagoenterostomy, are discussed. Anastomotic leakage is the main criterion for a choice of the most optimal procedure of forming an anastomosis. The contribution of the first and second rows of sutures to leakage is evaluated. An analysis of data on anastomotic leakage incidence points to the advantages offered by application of submerged esophagus-related anastomosis. A new modification of procedure of formation of muffle-type of esophagoenterostomy is presented. Leakage was registered in 1.3% which was due to technical errors during surgery. The non-reflux properties of the anastomosis are emphasized, with particular emphasis on its reliability, good functional characteristics, simplicity and wide range of application. The clinical applications are described.

[Combined surgery in gastric cancer]. / Kombinirovannye operatsii pri rake zheludka.

The authors analysed 725 clinical observations over patients who underwent combined operations for gastric carcinoma. The immediate and late-term results of these interventions were studied. Improvement of the operative techniques and the methods of pre- and postoperative management of the patients led to a decrease of the mortality to 12.3%. Five-year survival after combined operations in gastric carcinoma was 17.9 +/- 1.8%. The authors recommend specific drug therapy as an adjuvant measure in combined interventions in patients with endophytic and mixed forms of growth and metastases in the regional lymph nodes.