Abstract:

Introduction: congenital portosystemic venous shunts (CPVS) are rare vascular abnormalities that occur secondary to abnormal development or involution of fetal vasculature. They allow intestinal blood to enter the systemic circulation, bypassing the liver, which in the long term leads to various symptoms and complications. Today, thanks to advanced imaging techniques, the number of reported cases of CPVS is increasing, although for the most part these are single clinical cases or reports summarizing small series of cases. The overall incidence of CPVS is estimated at 1:30 000 births and 1:50 000 for those persisting beyond early childhood.

Material and methods: article consists of 44 foreign literature sources, that  highlight pathogenesis, classification, clinical picture, diagnosis and treatment of CPVS.

Conclusion: early diagnosis and correction of this anomaly using any (endovascular or surgical) occlusion regresses symptoms and prevents long-term complications. At present, given the rarity of this pathology, there is no large statistical analysis and no standards, developed for the management of this category of patients. However, further collection of material, an emphasis on the pathophysiology and anatomy of these lesions, will help to provide more effective care for patients with congenital portosystemic venous shunts.

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Abstract:

Diagnostic criteria for extranodal lymphoma (non-Hodgkin's lymphoma) are well known and described in the literature. However, primary extranodal lymphomas are rare and pose problems for differential diagnosis with primary or secondary lesions.

In the presented clinical case of a woman, 58 years old, with primary extranodal lymphoma of the stomach and spleen, an incorrect preoperative diagnosis was made: a tumor of the stomach and spleen abscess. It was mainly due to the presence of pain in the epigastric region and hospitalization for "severe acute biliary pancreatitis" in anamnesisd. Similar complaints and a "blurry" picture of manifestations of lymphoma did not allow her to be suspected preoperatively. The tumor nature of the focal lesion of the stomach was not in doubt, while the underestimation of MRI data, combined with the anamnesis, led to the erroneous diagnosis o f" spleen abscess". Patient underwent surgical operation: extended combined gastrectomy, distal resection of pancreas, splenectomy “en-bloc”, lymphadenectomy, cholecystectomy, “Roux-Y" reconstruction.

The clinical picture of extranodal lymphoma depends on its primary localization and the degree of its spread. Clinical manifestations of primary lymphoma of the stomach and spleen are often non­specific, therefore, against the background of previously transferred diseases of the hepatopancreatobiliary zone and their residual manifestations, an erroneous assessment of the situation is possible. In the presence of focal lesions, it is advisable to be more attentive to results of radiology examination, which can provide comprehensive information about their nature.

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Abstract:

Despite advances made in the treatment of renal cell carcinoma, kidney cancer still remains a «surgical» disease. Radical surgery is the only cure for this pathology If it is technically impossible to perform a resection of the kidney in situ, it is preferable to use the latter treatment option, since it avoids chronic hemodialysis, the need for kidney transplantation and improve the quality of life. The central and intraparenchymal location of tumors does not allow the organ-preserving operation due to the necessity of resection of segmental vessels, cups and renal pelvis, which prolongs the time of thermal ischemia. Conducting extracorporeal resection of the kidney in conditions of chemo-cold ischemia allows you to expand indications for organ-preserving treatment of patients with localized kidney cancer.

Aim: was to evaluate possibilities of ultrasound monitoring during extracorporeal resection of the kidney with orthotopic nephropexy and replantation of renal vessels at all stages of surgical treatment.

Material and methods: 47 patients (74% of men, 26% of women) with a histologically confirmed diagnosis of kidney cancer were hospitalized for treatment at the period from March 2012 to the present in A.V Vishnevsky National Medical Research Center of Surgery All patients underwent extracorporeal resection of the kidney under conditions of pharmaco-cold ischemia without intersection of the ureter with orthotopic replantation of renal vessels. Ultrasound examination (in B-mode, Color and Energy Doppler Imaging and pulsed Doppler) was performed for all patients in the pre-, intra- and postoperative stages.

Results: the analysis of the ultrasound data obtained during the surgical treatment of patients at its stages allowed us to develop an algorithm for examining patients at stages of extracorporeal resection of the kidney under conditions of pharmaco-cold ischemia without crossing the ureter with orthotopic replantation of the renal vessels, taking into account technical features of surgical intervention

Conclusion: extracorporeal resection of the kidney with orthotopic nephropexy and replantation of renal vessels requires constant dynamic monitoring of the functional state of the renal blood flow Doppler ultrasound, performed according to the developed method, is a highly informative method in the qualitative and quantitative assessment of intrarenal blood flow. Ultrasound monitoring allows you to determine the functional state of the kidneys during the preoperative stage, intraoperatively assess the state of vascular anastomoses and monitor changes in the kidneys and the resectior zone in the postoperative period. 

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Abstract:

Presented herein is a dynamic ultrasonographic study of soft tissue state in the area of a postoperative wound in 165 patients in order to determine rational policy of postoperative following up of the patient. The patients were subdivided into three groups: Group I - after an operative intervention for surgical pathology of abdominal and retroperitoneal organs; Group II - after herniotomy with combined plasty with a meshed endograft (Surgpro-mesh); Group III - after allografting of the aorta, major arteries of the lower limbs and neck. All patients after the surgical intervention were subjected to an ultrasonographic study of soft tissues of the abdominal wall, lower extremities, and neck in the B-mode in order to reveal pathological alterations, with determining the size, structure and indication of localization in relation to the surface of the skin; five cases suspected for infection of the process were subjected to duplex scanning of soft tissues around the focus revealed; detecting pathological alterations around the vessel or the graft after grafting of major vessels was followed by duplex scanning in order to determine the haemodynamic situation in the vessel or graft. The findings obtained suggest specificity of postoperative alterations characteristic of different surgical interventions, the revealing of which allows the surgeons to determine the policy of rational management of the patient, thus decreasing the risk of purulent complications in the area of the postoperative wound.

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22.   Бордаков В.Н., Абрамов Н.А., Савицкий Д.С. и др. Диагностика и лечение абсцессов брюшной полости. Сб. науч. трудов IV Всеармейской международной конференции: Интенсивная терапия и профилактика хирургических инфекций: М., 23 -24 сентября, 2004; 132 -133.

23.   Чебышева Э.Н. Оценка состояния аорты и ее ветвей убольныханевризмойбрюшнойаортыпо данным ультразвукового исследования. Автореферат дисс. канд. мед. наук. М., 2005; 25.

24.   Минайчев В. Ю, Конон Т. М. Абсцесс передней брюшной стенки. Новости лучевой диагностики. М., 2000; 30 -31.

25.   Биссет Р.А., Хан А.Н. Дифференциальный диагноз при абдоминальном ультразвуковомисследовании. (Под редакцией проф. Пиманова С.И.) М., Мед. литература. 2003; 232 - 233.

26.   Евдокимова Е.Ю. Лечебно-диагностические вмешательства под контролем ультразвука у больных с послеоперационными гнойными осложнениями. Автореферат дисс. канд. мед. наук.Красноярск. 2003; 26.

27.   Hill Robert MD, Conron Richard DO, Greissinser Paul DO, Heller Michael MD. Ultrasound for the Detection of Foreign Bodies in Human Tissue. Annal of Emergency Medicine. 1997; 29(3): 178 - 179.

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29.   Кунцевич Г.И. Оценка результатов хирургического лечения окклюзирующих поражений артерий. Ультразвуковая диагностика в абдоминальной и сосудистой хирургии. (Под редакцией проф. Г.И. Кунцевич). М., Кавалер Паблишерс. 1999; 191 - 195.

Abstract:

Purpose. Define the role of ultrasound diagnostics in preoperative evaluation, surgical approach, and postsurgical assessment in patients with cystous lesions of pancreas underwent various types of pancreatic distal resection (PDR).

Material and methods. Since 1995 till 2008 in Vishnevsky Institute of Surgery (Moscow) 54 patients with distal cystous lesions of pancreas received a course of treatment. Mean age was 50,6+1,2 years, 37 patients (68.5%) were women. Complex pre- and postoperative ultrasound study was performed in all the cases. Morphologically there were true cysts (2 cases), lymphocysts (1 case), postnecrotic cysts (21 patients), serous cystadenoma (9 cases), mucinous cystadenoma (16 cases), and mucinous cystadenocarcinoma (5 cases).

Results. After laparotomy and abdominal revision the following operations were performed:

1. Spleen-preserving distal pancreatic resection;

2. Distal pancreatic resection with splenectomy.

Pancreatic stump assessment revealed 2 possible complications: external pancreatic fistula and sub. phrenic abscess. Spleen-preserving interventions were shown to associate with fewer complication rate, than those with splenectomy.

Conclusions. The cardinal problem is that the PDR associates with repeatedly high complication rate, and the most common complications are external pancreatic fistulas and subphrenic abscesses. As far as the complication rate has the tendency to decrease in spleen-preserving interventions, it is advisable to avoid splenectomy in cases of benign pancreatic lesions.   

References

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3.        Шалимов А.А. Хирургия поджелудочной железы. М.: Медицина. 1964.

4.        Mayo W.J. The Surgery of the Pancreas: I. Injuries to the Pancreas in the Course of Operations on the Stomach. II. Injuries to the Pancreas in the Course of Operations on the Spleen. III. Resection of Half the Pancreas for Tumor. Ann. Surg. 1913; 58 (2): 145–150.

5.        Алимов А.Н., Исаев А.Ф., Сафронов Э.П. и др. Обоснование безопасности органосохраняющего метода лечения разрыва селезенки в хирургии изолированной и сочетанной травмы живота. Хирургия. 2005; 10: 55–60.

6.        Lee S.Y., Goh B.K., Tan Y.M. et al. Spleen-preserving distal pancreatectomy. Singapore Maed. J. 2008; 49 (11): 883–885.

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8         Буриев И.М., Икрамов Р.З. Дистальная резекция поджелудочной железы. Анналы хирургической гепатологии. 1997; 2: 136–138.

9.        Kimura W., Fuse A., Hirai I., Suto K. Spleen-preserving distal pancreatectomy for intraductal papillary-mucinoustumor. Hepatogastroenterology. 2004; 51 (55): 86–90.

10.      Edwin B., Mala T., Mathisen O. et al. Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg. Endosc. 2004; 18 (3): 407–411.

11.      Vezakis A., Davides M., Larvin M., McMahon M.J. Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg. Endosc. 1999; 13 (1): 26–29.

Abstract:

Fetal with fetal growth restriction (FGR) are at increased risk for acidemia, hypoxemia and adverse perinatal outcomes. Placental insufficiency and FGR are the most common and important clinical problems in obstetrics and the leading causes of perinatal morbidity and mortality. Lots of diagnostic procedures are assessed to evaluate FGR, among them ultrasounds are the most relevant ones. Advances in Doppler velocimetry have improved possibility of assessing cerebral blood flow in this pathology This article discusses the clinical case of brain-sparing effect in fetuses with FGR. Assessment of the fetal cerebral circulation provides important information on the hemodynamic changes associated with chronic hypoxia, intrauterine growth restriction and their clinical management. 

References 

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2.    Hutter D., Kingdom J., Jaeggi E. Causes and Mechanisms of Intrauterine Hypoxia and Its Impact on the Fetal Cardiovascular System: A Review. J. Pediatr. 2010; 2010: 9 pages.

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Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

Article exists only in Russian.

 Article exists only in Russian.

Article exists only in Russian.

Abstract:

Acute severe pancreatitis remains one of the actual issue in urgent surgery Forecast of the disease is dependant on spread of purulent necrotic process in pancreas and retroperitoneal tissues. Therefore diagnosis of purulent complications becomes extremely important.

The aim of the study was to demonstrate and evaluate features of ultrasonography in diagnosis and treatment strategy definition of purulent necrotic complications of acute severe pancreatitis.

Materials and methods. The study included 115 patients with acute destructive pancreatitis aged of 21-81 years The major part of them (50%) were persons at most able-bodied (working) aged 32-59 years. All patients underwent ultrasound diagnostics for determination the spread of pathology and detection of complications of the disease.

Ultrasound scanning was carried out as follows:

1. inspection of pancreatic parenchyma;

2. inspection of cellular tissues;

3. detection of free liquid in the abdominal cavity;

4. evaluation of the abdomen and kidneys;

5. inspection of the pleural cavity

Results. Examination of the parenchyma revealed that the pancreas was often inlarged, had a fuzzy, uneven contours and heterogeneous structure. However, it should be noted that in some cases, the pancreas was normal size and structure. Infected necrosis, acute liquid accumulation and/or free liquid in the abdominal cavity had occurred in 100% of cases in various combinations during examination of cellular tissues. Regarding the abdominal organs following complications were revealed: obstructive jaundice - in 5(4.3%) cases; portal vein thrombosis - in 1 (0.9%) case; splenic abscess - in 1 (0.9%) case. The presence of liquid in the pleural cavity was determined by leaves dissociation of the parietal and visceral pleura. The volume of the liquid was determined according standard classification.

Conclusion. Ultrasound scanning allows to determine the presence and extent of local complications arising at the stage of purulent necrotic complications of acute severe pancreatitis and general complications as a result of systemic pathological effect on the body of the disease.

References

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17.   Сидорова Ю.В., Шабунин А.В., Араблинский А.В., Шиков Д.В., Бедин В.В., Лукин А.Ю. Острый панкреатит: некоторые вопросы диагностики и лечения. Диагностическая и интервенционная радиология. 2011; 5(2): 15-26. 

Abstract:

Hepatocellular carcinoma (HCC) of liver is a widespread oncologic disease. The main risk factor of HCC development is liver cirrhosis. The aim of this article is to describe findings of HCCs in diagnostic imaging, including ultrasound, computed tomography, and magnetic resonance imaging. 

References

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3.     Weinmann A., Koch S., Niederle I.M. et al. Trends in Epidemiology, Treatment, and Survival of Hepatocellular Carcinoma Patients Between 1998 and 2009: An Analysis of 1066 Cases of a German HCC Registry. J. Clin. Gastroenterol. 2013 Sep 25. [Epub ahead of print].

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6.     Семендяева М.И., Меркулов И.А., Пастухов А.И. с соавт. Гепатоцеллюлярная карцинома - день сегодняшний. Клиническая практика. 2013; 2: 35-49. Semendyaeva M.I., Merkulov I.A., Pastukhov A.I. et al. Hepatocellular carcinoma - day today's. Klinicheskaya praktika. 2013; 2: 35-49 [In Russ].

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Abstract:

Diffuse liver lesion is one of the leading positions in the structure of hepatobiliary pathology Dispite the large number of available diagnostic methods biopsy followed by histological examination is a «gold standart» untill now. Bioimpedancemetry is a potential method of evaluation of morpho-functional analysys of the organ.

Aim: was to clarify dependence of indices of an electrical impedance of liver tissue on its morfo-functional status and to define general valuation principles of absolute and relative measures of an electrical impedance of an organ in case of liver diffusion pathology in an experiment.

Metarials and methods: the experimental study was carried out on 66 Wistar rats 180-230 g. The diffuse liver failure was modeled by using 0,02% solution of N-nitrozodiethylamin with water that animals were drinking during all the period of experiment (120 days). Bioimpedancemetry and morphological investigation as a next step were performed on 14, 30, 60, 90, 120 days in parallel with biochemical blood analysis, sonography of the liver and morphological analysis.

Results: biophysical parameters of liver's parenchyma in cases of toxic hepatitis were characterized by increasing of absolute bioimpedance indices more than 50% and increasing of impedance dispersion coefficient of 16%. But in cases of drrhosis of the liver biophysical paremeters were characterized by decreasing of absolute indices of electrical impedance and increasing of heterogeneity coefficient of the liver of 50 to 100% at different measurement frequencies.

Conclusion: obtained data confirm the diagnostic value of bioimpedancemetry and give prerequisites for further studying of parameters of an electric impedance of liver parenchyma in clinical practice.  

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