Contemporary trends in surgery of adrenal glands

There have been analysed the records of suprarenectomy in 459 patients with Conn' syndrome, syndrome of Icenko-Cushing as well as with androsteroma, pheochromocytoma and other tumors, who were operated in the clinic of abdominal surgery of S.P. Fedorov Russian Military Medical Academy. On the base of retrospective analysis the most actual aspects in surgery of the adrenal glands and the ways of the development of this branch of medicine have been determined. High effectiveness and perspectiveness of endovideosurgical removal of the adrenal glands is shown. Original and tested methods of choice of surgical approach, prophylaxis and treatment for some complications of suprarenectomy (adrenal insufficiency, Nelson' syndrome, etc.) are proposed. Substantiated policy in so-called hormono-inactive tumors of the adrenal glands is proposed.     

Lack of efficacy of two consecutive treatments of radioimmunotherapy with 131I-cG250 in patients with metastasized clear cell renal cell carcinoma.

PURPOSE: A previous activity dose-escalation study using 131I-labeled chimeric monoclonal antibody cG250 in patients with progressive metastatic renal cell carcinoma (RCC) resulted in occasional therapeutic responses. The present study was designed to determine the safety and therapeutic efficacy of two sequential high-dose treatments with 131I-cG250. PATIENTS AND METHODS: Patients (n = 29) with progressive metastatic RCC received a low dose of (131)I-cG250 for assessment of preferential targeting of metastatic lesions, followed by the first radioimmunotherapy (RIT) with 2220 MBq/m2 131I-cG250 (n = 27) 1 week later. If no grade 4 hematologic toxicity was observed, a second low-dose 131I-cG250 (n = 20) was given 3 months later. When blood clearance was not accelerated, a second RIT of 131I-cG250 was administered at an activity-dose of 1110 MBq/m2 (n = 3) or 1665 MBq/m2 (n = 16). Patients were monitored weekly for toxicity, and tumor size was evaluated by computed tomography once every 3 months intervals. RESULTS: The maximum-tolerated dose (MTD) of the second RIT was 1,665 MBq/m2 because of dose-limiting hematological toxicity. Based on an intention-to-treat analysis, after two RIT treatments, the disease stabilized in five of 29 patients, whereas it remained progressive in 14 of 29 patients. Two patients received no RIT, and eight of 29 received only one 131I-cG250 RIT because of grade 4 hematologic toxicity, formation of human antichimeric antibodies, or disease progression. CONCLUSION: In patients with progressive end-stage RCC, the MTD of the second treatment was 75% of the MTD of the first RIT. In the majority of patients, two cycles of 131I-cG250 could be safely administered without severe toxicity. No objective responses were observed, but occasionally two RIT doses resulted in stabilization of previously progressive disease.     

Mode of surgery completion in peritonitis

1310 patients with various forms of peritonitis were operated during 1989-1998. The tactics of the treatment was determined depending on bacterial contamination of the abdominal cavity. In abscesses of the abdominal cavity with massive bacterial contamination (6-7 CFU/g) drainage procedure was used. Mortality rate made up 4.8%. In local extended and diffuse peritonitis with a slight bacterial contamination of the abdominal cavity (3-5 CFU/g) and in absence of fibrinous deposition fixed on peritoneum, the drainage of the abdominal cavity was not used, and laparoscopy was performed in postoperative period for the control of the course of infectious process. Mortality rate was 0.6%. In extended peritonitis with massive bacterial contamination (6-8 CFU/g) the method of repeated explorations and sanitations of the abdominal cavity was used, mortality rate being 17.8%. The overall lethality made up 7.8%. Postoperative wound infection occurred in 6.7%, intraabdominal infection as abscesses or progressing peritonitis--in 2.1% of cases.     

Contemporary approach to the treatment of complicated diabetic angiopathy of the lower extremities

The experience of treatment of 278 patients with diabetes mellitus, complicated by the lower extremities diabetic angiopathy, was summarized. The authors had proposed the complex of treatment, including combined application of the high- and low-energy laser irradiation and catheterization of the shin arteries branches and the anterior abdominal wall superficial arteries for an adequate introduction of medicinal agents towards the affection focus. Application of the method proposed had promoted the results of treatment improvement, had permitted to proceed with economical amputation of extremity and to escape the reoperations performance.     

Endoprosthesis of mammary glands using hydrogel prosthesis PAAG "Interfall"

The results of the mammarial glands endoprosthesis in 60 women patients, of them in 57--with prostheses PAAG "Interfall", applied for the first time, were analyzed. The occurrence frequency for postoperative complications was 19%, including sensitivity disorders of papillo-areolar complex were noted in 14% of observations and seroma--in 5%. Preoperative, intraoperative, postoperative tactic of management of women patients, operated for the first time and with purulent-septic complications occurring after mammoplasty using application of gel and prostheses PAAG "Interfall" was elaborated.     

Analysis of complications of operation for appendicular peritonitis in children

Complications, occurred after the operation for appendicular peritonitis in children, were analyzed. The frequency of the complications occurrence in patients with an acute catarrhal appendicitis had constituted 1.4%, with phlegmonous one--3.5%, gangrenous--12.1%, gangrenous appendicitis with local restricted peritonitis--18.9%, with diffuse purulent peritonitis--42%. The dependence of the complications frequency on character and severity of primary changes in abdominal cavity was established.     

The ATP, phosphoenolpyruvate contents and the hexokinase activity in erythrocytes in injured persons with the pulmonary gun shot wound

The adenosine triphosphate and phosphoenolpyruvate contents in erythrocytes are enhancing before and in early terms after the operation for the gunshot lungs parenchyma damage. The study of molecular mechanisms of the lungs pathology allows to evaluate the severity of their damage, to substantiate the operative treatment tactic and the medicinal therapy principles.