Thyroid metastasis of vaginal leiomyosarcoma: a case report and review of the literature.

Metastasis of vaginal leiomyosarcoma to the thyroid gland is an extremely rare event. Here, we report a case of thyroid metastasis of vaginal leiomyosarcoma. A 65-year-old female patient presented with a multinodular toxic goiter. 5 years earlier the patient has undergone a radical vaginal resection followed by chemotherapy due to high-grade vaginal leiomyosarcoma. Fine-needle aspiration cytology of the right thyroid lobe was suggestive of the benign thyroid lesion. As the diagnosis was not clear, following a multidisciplinary team discussion the decision was made to proceed with a total thyroidectomy. Pathologic assessment of the tumor confirmed thyroid metastasis of vaginal leiomyosarcoma.

[AN ASSESSMENT OF REAL AND POTENTIAL LOSSES DUE TO PREMATURE DEATH FROM CEREBROVASCULAR DISEASES AS A TOOL FOR MANAGEMENT DECISIONS].

Aim -to calculate and estimate the number of years of potential life lost (YPLL) due to premature mortality from cerebrovascular diseases in Ukraine, and its share in the array of losses from all diseases of the circulatory system. The information base of the study was official data of the State Statistics Service of Ukraine on the distribution of the deceased by gender, age groups and causes of death in 2018. A comparative analysis of mortality from cerebrovascular diseases in selected countries was carried out using the European database of mortality (MDB) and the database of the Global Study of Disease Burden, Injuries and Risk Factors. The method of potential demography was used to estimate demographic losses due to premature mortality from cerebrovascular diseases. The number of lost years of potential life due to premature mortality from cerebrovascular diseases in 2018 reached 116,563 thousand man-years (104,355 thousand in 2013), which accounted for more than 18% of similar losses as a result of death from all cardiovascular diseases in Ukraine. Revealed a significant disproportion of losses depending on gender - more than two thirds (69.1%) of the absolute number of lost years accounted for men. Ukraine is losing more significant amounts of potential years of life due to high premature mortality from cerebrovascular diseases compared to the developed countries of the world. Assessing real and potential losses due to premature death from cerebrovascular disease is a useful tool to support management decision making. We can recommend a methodology for arguing the development of strategies and programs aimed at combating cerebrovascular diseases, assessing the dynamics of changes in the process of their implementation, and as an indicator of effectiveness.

Parathyroid carcinoma: a case report.

Parathyroid carcinoma (PC) is an uncommon cause of primary hyperparathyroidism (pHPT). The tumor is mostly functioning with following high serum calcium and parathyroid hormone (PTH) levels. Consideration of PC in differential diagnosis of pHPT is important because the mortality and the prognosis depend on early recognition and surgical approach. A case of PC in 51-year old female patient with persistent pHPT is reported. A patient, referred with anterior cervical hematoma, dysphagia, underwent neck ultrasound, barium X-ray swallow test and neck computed tomography. On the posterior surface of left thyroid lobe, close to the esophagus the heterogenic lesion with irregular margins was found. The preoperative calcemia was slightly elevated. The patient underwent cervical exploration with parathyroidectomy. Histological exam showed parathyroid lesion with immunohistochemical confirmation of PC. After 2 months follow-up there are no signs of a residual-recurrent disease. Although laboratory tests revealed pHPT preoperatively, no clinical effects of elevated calcium and PTH concentration levels were presented. As histological features are not specific for the differential diagnosis between the parathyroid adenoma and PC, the immunohistochemistry remains the only useful tool for the definite diagnosis.

A case report of late local relapse of adrenocortical carcinoma 18 years after adrenalectomy.

Adrenocortical cancer is an extremely rare tumor presenting with extensive locoregional spread at the time of diagnosis. Due to the diagnostic difficulties preoperatively and a lack of effective treatment options, patients have poor prognosis. Patients succumb to metastases within a couple of months. Only 20 cases have been so far reported in the literature with a medium disease-free survival up to 2 years. We present a case of a locoregional recurrence of adrenocortical cancer 18 years after left adrenalectomy.

[Comparative evaluation of effectiveness of narcotic analgesics for intravenous autoanalgesia]. / Sravnitslnaia otsenka éffectivnosti narkoticheskikh analgetikov, ispolzuemykh vnutrivenno pri autoanalgezii.

The three groups of patients who had morphine hydrochloride, phentanyl and dipidolor been used for intravenous autoanalgesia were examined. In each group, the state of the central hemodynamics, pulmonary ventilation and gas composition of the blood were studied. The effectiveness of analgesia was assessed, side effects were considered. The effectiveness of the use for postoperative intravenous autoanalgesia of morphine and phentanyl has been proved.

[Comparative evaluation of the effectiveness of various narcotic analgesics after intravenous autoanalgesia]. / Sravnitel'naia otsenka éffektivnosti nekotorykh narkoticheskikh anal'getikov pri vnutrivennoi autoanalgezii.

The article is devoted to an investigation of intravenous analgesia with different narcotic analgetic drugs (phentanyl, morphine, dipidolor). A comparative assessment of the influence upon central hemodynamics, lung ventilation, acid-base metabolism and blood gases was performed, as well as the degree of analgesia in using these drugs. A conclusion is made that morphine and phentanyl are preferable for the intravenous postoperative autoanalgesia.

[The choice of a method for postoperative analgesia using fentanyl]. / Vybor metoda posleoperatsionnogo obezbolivaniia s ispol'zovaniem fentanila.

The comparative assessment of the methods of postoperative analgesia with the use of phentanyl: continuous intravenous infusion of a preparation, intravenous autoanalgesia, combined intravenous autoanalgesia with phentanyl and analginum was carried out. The authors consider as an optimal method of analgesia in patients after operations on the abdominal organs the combined intravenous autoanalgesia with phentanyl and analginum.