[Hyper- and hypoaldosteronism].

The literature review devoted to pathogenesis of the development of hyper- and hypoaldosteronism is presented. Based on the analysis of Russian and English-written literature known and clinically significant diseases arising due to hyper- and hypoaldosteronism are presented. Pathogenetic mechanisms inducing the development of primary and secondary forms of hyper- and hypoaldosteronism were enlightened. Furthermore the data on mechanisms of formation of hyper- and hypoaldosteronism are given.

[Cardiac arrhythmias during an elective cholecystectomy].

The paper presents systemized literature data on cardiac arrhythmias (CA) associated with cholecystectomies. The authors present an analysis of CA in 101 patients with chronic calculous cholecystitis (CCC), registered before, during and after an elective cholecystectomy (the surgery was performed either through laparotomy or using endovideosurgical technique). The study revealed that cholecystectomy, especially laparatomic one, bore an arrythmogenic effect. Additional predictors of dangerous CA associated with surgical treatment of CCC, were presence of sinus tachycardia, bradycardia, ciliary arrhythmia, changes in the variability of heart rate, and preoperative heart enlargement.

[Arterial hypertension in patients with undifferentiated adrenal tumors]. / Arterial'naia gipertoniia u bol'nykh s nedifferentsiruemymi opukholiami nadpochechnikov.

AIM: To study clinical and laboratory manifestations of hormonal activity in hypertensive patients with undifferentiated adrenal tumors. MATERIAL AND METHODS: 40 patients (19 males and 21 females aged 16-60 years) with undifferentiated adrenal tumors were examined. They were treated surgically. The results of the examination were compared with histological evidence on the resected adrenals. Clinical and laboratory signs of hormonal activity of the tumor were ascertained. RESULTS: Clinical symptoms in patients with adrenal tumors differed from those of typical symptoms of Icenko-Cushing, Cohn syndromes, pheochromocytoma. Hypertension in patients with cortical tumor may arise because of high synthesis of hydrocortisone, in patients with medullary tumor--of catecholamines. However, the level of hormones was not high enough for development of classic syndromes. That's why these tumors were named undifferentiated. CONCLUSION: Adrenal cortical tumors have signs of mixed androgeno-mineral-glucocorticoid activity. In medullary adrenal tumors hypersecretion of catecholamines is associated with cortical hyperfunction.

[Transcostal lumbo-laparatomy in adrenal surgery]. / Transkostal'naia liumbolaparotomiia pri operatsiiakh na nadpochechnikakh.

The most common surgical approaches to adrenal gland tumors were analyzed. New original approach in adrenal surgery--transcostal lumbotomy--was developed and used in 175 patients. It is demonstrated that transcostal lumbolaparotomy has the best spatial parameters of surgical wound compared with other known approaches in adrenal surgery.

[Cerebral, central and intracardiac hemodynamics in patients with progressive arterial hypertension following the surgical suppression of adrenal hyperfunction]. / Sostoianie tserebral'noi, tsentral'noi i vnutriserdechnoi gemodinamiki u bol'nykh progressiruiushchei arterial'noi gipertenziei posle khirurgicheskogo podavleniia giperfunktsii nadpochechnikov.

Forty-eight patients with progressive (malignant) arterial hypertension resistant to conservative therapy were subjected to surgical portalization of the adrenal blood stream in order to metabolize excessively produced aldosterone in the liver of the patients. Cerebral hemodynamics was studied before by tetra- and bipolar rheoencephalography, central hemodynamics was studied by tetrapolar transthoracic rheography, and intracardiac hemodynamics by echocardiography before and after surgery; blood plasma aldosterone and hydrocortisone concentrations and plasma renin activity were measured. A significant reduction of arterial pressure, elimination or alleviation of subjective and objective manifestations of chronic hypertensive encephalopathy were seen in the majority of patients after surgery. Cerebral blood flow improved, blood plasma aldosterone and renin activity reduced, myocardial hypertrophy decreased, and a trend to normalization of intracardiac hemodynamics was observed.

[The indications for the suppression of adrenal hyperfunction in a progressive course of hypertension]. / Pokazaniia k podavleniiu giperfunktsii nadpochechnikov pri progressiruiushchem techenii gipertonicheskoi bolezni.

The authors analyze the results of the surgical treatment of patients with progressive essential hypertension (PEN). The treatment involved cryodestruction (adrenalectomy) of the right adrenal and autotransplantation of the left adrenal on the vascular peduncle into the transverse mesentery. Before the operation the data on water-salt homeostasis, central and cerebral hemodynamics and on the renin-angiotensin-aldosterone system attested to PEH. 1 to 3 years after the operation natriuresis was revealed (210% of the initial value), as were a decrease of the total peripheral vascular resistance, amelioration of the cerebral blood flow and peripheral blood aldosterone lowering from 246 +/- 17 to 90 +/- 14 sh/ml.

[Methods of suppression of adrenal hyperfunction]. / Sposoby podavleniia giperfunktsii nadpochechnikov.

Evolution of the methods for suppression of adrenal hyperfunction has now made it possible to give up bilateral adrenalectomy in favour of portalization of the adrenal blood flow from the left adrenal by its autotransplantation with maintained blood supply into the transverse mesocolon and cryodestruction of the right adrenal. Analysis of the mortality showed two-stage suppression of adrenal hyperfunction to be advisable.

[Non-extirpation methods of suppressing adrenal gland hyperfunction in severe course of arterial hypertension]. / Neekstirpatsionnye metody podavleniia giperfunktsii nadpochechnikov pri tiazhelom techenii arterial'noi gipertenzii.

The authors report on using cryodestruction of the adrenals in 30 patients. Four patients died during the postoperative period. The operation of cryodestruction of the adrenals is considered by the authors to be technically simpler than resection of the adrenals.

[Role of prolonged enzyme therapy in the combined treatment of prolonged non-healing wounds]. / Rol' prolongirovannoi énzimoterapii v kombinirovannom lechenii dlitel'no nezazhivaiushchikh ran.

Efficiency of combined treatment of long non-healing wounds with the help of immobilized bacterial protease (profezyme) is shown. The data obtained suggest prolonged enzyme therapy with profezyme to reliably shorten the time of debridement of the wound, to stimulate the development of granulations, thus contributing to better results of plastic closure of skin defects in long non-healing wounds.

[Course of the wound process during treatment with immobilized proteolytic enzymes]. / Techenie ranevogo protsessa pod vliianiem immobilizovannykh proteoliticheskikh fermentov.

Clinical, morphological, biochemical and bacteriological examinations have shown the immobilized proteolytic enzyme "profezym" to shorten the phase of cleaning the wound and in combination with antiseptic drugs to lessen the bacterial dissemination of the tissues as well as to strengthen and accelerate regeneration processes both in acute pyo-necrotic diseases and in continuous non-healing wounds.