[Use of an ex vivo technique in a patient with renal arteriovenous malformation in complication endovascular treatment]. / Ispol'zovanie tekhniki ex vivo u patsienta s arteriovenoznoi mal'formatsiei pochek pri oslozhnenii éndovaskuliarnogo lecheniia.

Renal arteriovenous malformation is a rarely encountered disease characterized by the presence of a direct arteriovenous shunt between the renal artery and vein. This nosology was first described by Varela in 1928, and by 1997 the number of such cases amounted to slightly more than 200. Endovascular closure of a fistula seems to be an attractive method of treatment in view of low traumaticity and a short period of rehabilitation. However, as shown by our case report, this type of intervention in large-diameter fistulas may be associated with the development of life-threatening complications. In case of rupture of the renal capsule and/or arteriovenous aneurysm, radical nephrectomy, unfortunately, remains to be a method of choice. Described below is a case concerning treatment of a female patient presenting with bilateral arteriovenous malformations and the world's first emergency operation for a ruptured intraparenchymatous arteriovenous aneurysm using an extracorporeal technique.

[Extracorporeal partial nephrectomy under pharmaco-cold ischemia for renal cell carcinoma]. / Ékstrakorporal'naia rezektsiia pochki v usloviiakh farmakokholodovoi ishemii pri pochechno-kletochnom rake.

AIM: To develop the method for extracorporeal partial nephrectomy under pharmaco-cold ischemia without ureter intersection with orthotopic replantation of renal vessels for RCC. MATERIAL AND METHODS: The study included 37 patients with morphologically confirmed RCC pT1a-Т3bN0M0-1G1-3 with intraparenchymal and central location of the tumor in cases of single kidney, comorbidity of contralateral kidney and kidney on the side of lesion. RESULTS: Mean surgery time was 413.97±89.14 minutes. Mean time of warm ischemia was 8.39±4.75 minutes, cold ischemia - 151.41±41.29 minutes. Intraoperative and postoperative complications were detected in 3 (8.1%) and 18 (48.6%) patients respectively. CONCLUSION: Extracorporeal partial nephrectomy under pharmaco-cold ischemia without ureter intersection with orthotopic replantation of renal vessels for RCC is a relatively safe organ-sparing treatment. It provides resection of large tumors with any location under prolonged cold ischemia without ureter intersection.

[Robot-assisted operations in pelvic region].

Nine patients were operated on with the use of robotic complex. In 3 cases the nonorganic retroperitoneal pelvic tumor was removed, the 4 full-layer urinary bladder and ureteral orifice resections and simultaneous ureteral plasty together with ileal-obturatory lymphadenectomy (2 - cancer of the urinary bladder cervix, 1 - pheochromocytoma of the urinary bladder) and 2 ureterocele with complete ureter duplication and megaureter were performed. Technical aspects of the robotic layerwise resection of the neck of the urinary bladder were worked out. The operation time varied from 1 hour 45 minutes to 4 hours 45 minutes. The maximal blood loss was 100 ml. One patient developed the acute respiratory failure. The were no other postoperative complications. The postoperative hospital stay was 7-12 days.

[Some molecular-genetic markers, defining the pathogenesis of superficial and invasive bladder cancer].

We have investigated deletions of 3p14, 9p21, 9q34, 17p13 (TP53) loci, activating FGFR3 mutations in exon 9 and aberrant methylation of RASSF1, RARbeta, P16, P14, CDH1 genes with the aim of the molecular pathogenesis pathways analysis of bladder cancer. FGFR3 activating mutations and 9p21 deletions were observed significantly more frequent in the group of non-invasive bladder cancer pTa than in minimally-invasive cancers pT1 (p = 0.004 and 0.006 respectively). It was shown that groups of superficial and invasive bladder cancer are significantly differing in the frequency of 17p13 (p = 0.006) and 9q34 (p = 0.04) deletions and in aberrant methylation of the gene P16 (p = 0.02). We have revealed some differing molecular-genetic alterations in groups of superficial and invasive bladder cancers. Therefore we suppose that these two types of bladder cancer might have different pathways of development.