RATIONALE FOR THE APPLICATION OF CALCITONIN LEVEL IN THE EARLY POSTOPERATIVE PERIOD TO EVALUATE THE EFFECTIVENESS OF SURGICAL TREATMENT OF MEDULLARY THYROID CANCER.

Purpose: To determine the effectiveness of the basal calcitonin (CTb) determination in the early postoperative period to predict the possible recurrence (persistence) of medullary thyroid cancer (MTC). Material and Methods: A retrospective study of the treatment results in 194 patients with MTC (148 (76.3%) primary - group 1 and 46 (23.8%) recurrent - group 2) according to the levels of CTb in the first week after surgery and one year later. All groups were analyzed by staging, the level of preoperative and postoperative basal calcitonin 5 days and 1 year after the primary surgery. Findings: Among all patients, women prevailed - 144 (74.2%), the average age was (48.7±15.2), the average follow-up period was 67.5 months. Basal calcitonin was studied in patients of all groups in the preoperative and serially in the postoperative periods: 5 days and 1 year after the most radical surgical volumes. To test the hypothesis about the possibility of using CTb indicators in the early postoperative period, the degree of compliance with normal calcitonin indicators (≤18 pg/mL) was assessed by observation groups 5 days and 1 year after surgery. Conclusions: 1. The CTb value 5 days after surgery is no less a reliable marker of the result of surgical treatment of MTC than the currently recommended CTb measurement 2-3 months after surgery. 2. The technique is applicable for both primary and reoperations used for recurrent forms of medullary thyroid cancer.

["Incidental" thyroid carcinoma among patients in surgical treatment for nontumors thyroid desease].

Incidence of unexpected diagnosis of thyroid carcinoma among operations on benign thyroid surgical diseases (nodular goiter and Graves' disease) was studied in 608 patients within 2008-2009 years in specialized clinic of endocrine surgery. In 56 (9.2%) patients the "incidental" thyroid carcinoma including 43 (77%) - papillary microcarcinoma were diagnosed in histological investigations. In 10 (18%) patients which were performed within the first postoperative week. Repeated surgery demonstrates increased risk of complication (damage of parathyroid glands, recurrent laryngeal nerves and other anatomic structures of neck) considering less favoring conditions for secondary operations, it is worth to implement wider indications to frozen section, radical primary operation (total thyroidectomy at multi-nodular bilateral goiter and Graves' disease), and also maximal complete examination prior to surgery.

[Radionuclide examination of functional disorders in patients with acute abscess of lung]. / Radionuklidnye metody issledovaniia funktsional'nykh narushenii u bol'nykh s ostrym abstsessom legkogo.

Potential of radionuclide examination for study of external respiratory function is discussed. Results of examination of 42 patients with lung abscess are analyzed. Procedure of perfusion and ventilating aerosol pulmonoscintigraphy with (99m)Tc-pentatex is described in detail. This procedure permits to examine alveolar-capillary diffusion. Variants of synchronous and asynchronous variations of indices of ventilating-perfusion correlations are demonstrated. These methods are safe and non-invasive. They may be recommended for functional assessment of regional and total characteristics of external respiration of each lung separately, and also for diagnosis of predominance of ventilating or perfusion dysfunction. Clearence of pentatex excretion from right and left lung characterizes integrity of epithelium and alveolar-capillary membrane. It is the index of alveolar-capillary permeability.

[Thoracoabscessotomy in combined treatment of lung gangrene]. / Torakoabstsessotomiia v kompleksnom lechenii bol'nykh gangrenoi legkikh.

Patients with gangrene and gangrenous abscess of the lung belong to the most severe group of patients with purulent lung diseases. Conservative treatment is not effective, lethality after lung resection or pneumonectomy ranges from 20 to 70%, therefore the study of less traumatic but life-saving operations is topical. From 1996 to 1998, 296 patients with purulent destructive processes in the lung were hospitalized, 34 of them had gangrene or gangrenous abscess of the lung with significant intoxication. Thoracoabscessostomy by original method with consecutive necrectomies, sanitation of purulent cavity was performed in 27 patients. After operation 2 patients died, 25 patients were discharged with clinical recovery in satisfactory conditions, with dry cavity in the lung. In remote terms the cavities are cicatrized or transform to spurious cysts. Indications for thoracoabscessostomy are formulated. It is method of choice in the treatment of patients with gangrenous lung abscess, when conservative treatment is not effective, but the risk of radical operation is very high.

[Some problems of the morphogenesis of bullous emphysema of the lungs]. / Nekotorye voprosy morfogeneza bulleznoi émfizemy legkikh.

The analysis of 93 cases of bullous pulmonary emphysema provided evidence for the significance of valvular mechanism of bulla formation operable at two levels: in small bronchi and bronchioles on the one hand and in the area of subpleural fibrosis on the other hand, the latter arising in the result of subpleural atelectasis or subpleural carnificating pneumonia. Relevant pathology is characterized by peripheral acinus situated tangentially to the pleural surface. Electron-microscopic examination revealed pneumocytes of the second type on the internal bulla surface.