Current aspects of diagnosis and treatment of patients with neuroendocrine tumors

The article presents modern possibilities and existing problematic aspects of the choice of therapeutic and diagnostic tactics in patients with neuroendocrine tumors of the gastrointestinal tract and pancreas are presented. The asymptomatic course of neuroendocrine tumors of the gastrointestinal tract and pancreas was established in 18.5% and 24.6% of cases, respectively. Carcinoid syndrome was detected in 12.9%. The sensitivity rates of chromogranin A and neuron-specific enolase in the diagnosis of tumors were 54% and 13%, respectively. The levels of cancer-embryonic antigen in G-1/G-2 and G-3 tumors were 5 ng/ml and 8.9 ng/ml, respectively (p 0.001). A pathognomonic sign of neuroendocrine tumors of the small intestine is a mesentery tumor conglomerate, and the sensitivity rates of computed tomography and positron emission tomography with 68Ga to detect this sign were 92.3% and 92.9%, respectively (p 0.05). The computed tomographic density of neuroendocrine pancreatic tumors G-1/G-2 in the arterial phase was 112.1 40.2 HU and that of G-3 tumors was 54.0 10.4 HU (p = 0.025). Surgical treatment was performed in 259 (79.7%) patients. Postoperative complications that developed in localized and locally distributed neuroendocrine tumors of the gastrointestinal tract and of the pancreas were found in 3.5% and 8.8%, and in 58.1% and 40% of the cases, respectively, and those of generalized tumors were noted in 20%. The tumor-specific 5-year survival rates of patients with localized neuroendocrine tumors of the gastrointestinal tract and pancreas were 92.5% and 94.4%, those with locally distributed tumors had 66.8% and 77.8%, and those with generalized tumors had 51.8% and 47.1%, respectively. In patients with generalized tumors, the 5-year survival rates after cytoreduction and removal of the primary tumor were 88.2% and 64.6%, respectively (p = 0.097), and the rate after drug therapy was 28.8% (p 0.001). The prognosis of the 5-year survival of patients is determined by the degree of malignancy and tumor localization, treatment method, and patient age. In general, neuroendocrine tumors are a heterogeneous group of neoplasms that require a multidisciplinary approach to diagnosis and choice of therapeutic strategies.

Safety in parathyroid surgery: innovation in diagnostic and minimally invasive operations

The main treatment method of primary and tertiary hyperparathyroidism is surgery. However, surgical interventions on the parathyroid glands can lead to formidable complications such as laryngeal paresis and hypocalcemia. With this background, a comprehensive study examined the effectiveness of modern methods of diagnosis and surgical treatment of hyperparathyroidism to increase the safety level in surgery of the thyroid gland. The results of a comprehensive examination and treatment of 53 patients with hyperparathyroidism who underwent surgery using three methods were analyzed: traditional (n = 18/34); minimally invasive endoscopically assisted (n = 32/60), and endoscopic (transoral) (n = 3/6). Intraoperative neuromonitoring was also performed in all surgical interventions. Parathyroidectomy was performed under parathyroid monitoring for intraoperative topical diagnosis of parathyroid tumors in nine patients. The use of minimally invasive endoscopically assisted access to the parathyroid glands, as an alternative to the traditional approach, indicated that the preoperative potential in the diagnosis of parathyroid disorders. Moreover, intraoperative neuromonitoring and parathyroid monitoring demonstrated efficiency based on the decline in the incidence of specific postoperative complications with a tolerable increase in operative time, maintenance of the average duration of stationary treatment after surgery, and increased safety level of surgical treatment of hyperparathyroidism.

Comprehensive assessment of hemorrhoidectomy with lateral ultrasonic dissection in the “cut” mode

The effectiveness of the original technique of hemorrhoidectomy with lateral ultrasonic dissection in the cutting mode was analyzed from a clinical standpoint and studied according to pathomorphological changes in tissues during its use. A comparative assessment of the immediate results of treatment as well as pathomorphological changes in the tissue of removed hemorrhoids in two groups of patients was performed. The main group included 30 patients in whom the original hemorrhoidectomy technique with lateral ultrasound dissection in the cutting mode was used. The control group consisted of 30 patients who underwent Milligan Morgan hemorrhoidectomy using electrocoagulation. No significant difference was found between these groups in terms of the age and sex structure of patients, as well as the main clinical characteristics of the disease. In a comparative analysis of the immediate treatment results, the intensity of the pain syndrome and the incidence of postoperative complications were lower in the main group than in the control group. In the assessment of pathomorphological changes, the depth of coagulation necrosis and the severity of necrobiotic changes in the underlying layer after hemorrhoidectomy with lateral ultrasonic dissection in the cutting mode were significantly less than those after Milligan Morgan surgery using electrocoagulation. A significant difference was also revealed in the timing of tissue regeneration. The formation of active granulations in the postoperative wound area in the main group was noted on postoperative days 1416, while this process developed no earlier than on postoperative day 20 in the control group. As a result, complete epithelialization of wounds after hemorrhoidectomy with lateral ultrasound dissection in the cutting mode occurred much earlier, i.e., postoperative days 2630. A similar process after the Milligan Morgan hemorrhoidectomy using monopolar coagulation was completed only on postoperative days 3638. Thus, the use of the original technique of lateral ultrasound dissection provides a more sparing effect on tissues, which is the key to a favorable course of the postoperative period and rapid rehabilitation of patients.

Infectious and inflammatory complications after endoscopic hernioplasty in patients with postoperative ventral hernias: features of diagnosis and treatment strategies

An algorithm for the diagnosis and treatment of infectious and inflammatory complications after endovideosurgical hernioplasty in patients with postoperative ventral hernias using traditional and minimally invasive methods of therapy was proposed. The study was based on the treatment results of 177 patients who underwent endovideosurgery for postoperative ventral hernias. Despite the perioperative antibiotic prophylaxis according to the accepted at the S.M. Kirov Military Medical Academy, according to the protocol scheme (first-generation cephalosporin at a dose of 1 g once parenterally 30 min before the operation, followed by repeated administration in case of operation duration of 3 h), course of the early postoperative period on days 35 in 8 (4,5%) patients after endovideosurgical hernioplasty was complicated by suppuration in the intervention area. When analyzing the causes of infectious and inflammatory complications, in both the main and control groups of observations, all suppuration in the area of surgical interventions was diagnosed in patients with metabolic syndrome (stages IIIII obesity and type 2 diabetes mellitus). The use of the negative pressure wound therapy resulted in wound cleansing for 4.1 2.5 days (p 0.05) and was comparable with the traditional method of treatment, but more active growth of granulation tissue prevailed in the wound, which contributed to its accelerated healing. The negative pressure wound therapy is effective in the systemic infectious and inflammatory process, especially after prosthetic hernioplasty of large W3-postoperative hernias. Drainage of abscesses under ultrasound navigation is possible with small (S 10 cm2) delimited purulent processes in the area of the polypropylene implant with the preservation of the latter.

Screening of potential donors for immunoglobulins M and G to new coronavirus infection

This study presents the results of the examination of potential donors of blood and its components for immunoglobulins M and G to patients with coronavirus disease 2019 (COVID-19) living in St. Petersburg. A total of 6782 people aged 1824 years were evaluated, which accounted for 2.07% of the regions population (326 760 people) of this age group. The study was carried out in the spring and autumn of 2020. A negative result (absence of antibodies) was obtained in 93.5% of the participants. The rates of immunoglobulins M and M + G were 0.58% and 4.18%, respectively, in the spring and autumn. Moreover, the number of participants who had immunoglobulins M and G + M in the autumn period was four times higher than the indicators of the spring period, which indicated greater infection activities in the population during this period. This is most likely due to the active movement of the population in the summer. When comparing the rates of COVID-19 infection and the frequency of occurrence in donors of the same age, markers of human immunodeficiency virus 1 and 2 and hepatitis B and C in 2020 (0.024, 0.012 and 0.13%, respectively) indicate the urgency of the problem of donor selection during blood services, especially during a difficult epidemiological situation because of COVID-19. Along with organizational measures for the selection of donors (e.g., attracting individuals from organized groups in which there are no signs of an unfavorable epidemiological situation to donation), mandatory testing of potential donors for immunoglobulins M and G should be considered.

Professor Ivan Diomidovich Kudrin (100th birth anniversary)

This article highlights the stages of professional activity of the outstanding Russian military scientist-physiologist, Ivan Diomidovich Kudrin, in the course of solving scientific problems of habitability and medical and psychological support in the Armed Forces of the Russian Federation. Ivan Diomidovich headed the leading scientific division, which is a scientific and methodological center in the Union of Soviet Socialist Republics Armed Forces on habitability and professional selection problems. Thanks to the experimental and practical activities of the unit led by him and his direct participation, concepts of habitability factor rationalization and medical and psychological support of personnel at various stages of military service were theoretically, experimentally, and practically justified as separate complex areas of military preventive medicine and psychology. Under the leadership of Ivan Diomidovich, normative and technical documents were developed to regulate the implementation of military improvement and professional performance in the Armed Forces of the Soviet Union. The ideo logy of habitability and medical and psychological support created by I.D. Kudrin and his scientific school formed the basis for todays successful work of two scientific research center departments.

Эндогенный гиперкортизолизм: достижения и перспективы в диагностике и лечении

The results of examination and treatment of 647 patients with endogenous hypercortisolism were studied: pituitary corticotropinoma was detected in 494 (76.4%) patients, corticosteroma and pre corticosteroma of the adrenal gland in 142 (21.9%), bilateral macro-nodular hyperplasia of the adrenal glands of primary adrenal origin-in 11 (1.7%). Differential diagnosis of clinical forms of endogenous hypercortisolism was based on the assessment of the level of adrenocorticotropic hormone and cortisol, both in peripheral blood, and with selective bilateral blood sampling from the adrenal veins and lower stony sinuses, and the study of the nature of samples with 8 mg of dexamethasone. Topical diagnostics consisted in assessing the state of the adrenal glands and pituitary gland during computed tomography and magnetic resonance imaging with the use of contrast agents, and the use of special software 3D-Volume Rendering Technique allowed optimizing tactical and technical approaches to performing surgical interventions. Of the operated patients with adrenocorticotropic hormone dependent endogenous hypercortisolism, total removal according to the control magnetic resonance imaging was achieved in 92.3% of cases, subtotal in 7.7%. However, hormonal remission was achieved only in 82.4% of cases. All patients with corticosteroma and pre-corticosteroma of the adrenal gland underwent adrenalectomy: in 6 patients by open method, in 136 patients by endovideosurgical method (in 11 patients by laparoscopic method, in 124 patients by retroperitoneoscopic method, and in 1 patient by thoracoscopic transdiaphragmatic adrenalectomy). In all patients, the operation led to recovery. Patients with benign macronodular hyperplasia of the adrenal glands needed conservative treatment with steroidogenesis blockers. Indications for surgical treatment in the volume of unilateral adrenalectomy occurred only in 2 patients.

The 100th birth anniversary of Ravil Garifovich Imangulov

October 12, 2021, marks the 100th anniversary of the birth of the Head of the Department of Medical Protection, Head of the Department of Armed Defeat and Protection of the Medical Academy, the Great Patriotic War, Doctor of Medical Sciences, Professor, and Colonel of the Medical Service, Ravil Garifovich Imangulov. For many years, R.G. Imangulov fruitfully worked in the field of military medical science and gone through all formational stages of a scientist and a teacher from an adjunct to the head of the department and professor-consultant of the Academic Council of the Military Medical Academy. During his service at the Military Medical Academy, Professor R.G. Imangulov took an active part in testing weapons of mass destruction and special field experimental studies in various regions of the country, aimed at the practical implementation of the latest achievements in the field of medical and technical means of anti-chemical and anti-radiation protection. For a long time, under his leadership and with his direct participation, fundamental research was carried out on the fundamentals of medical protection of troops and population from mass destruction weapons. His achievements in the field of medical protection against mass destruction weapons, both educational and scientific and practical disciplines, are of great importance for Russian military medicine. His fruitful years of activity did not only result in monographs, textbooks, teaching aids, scientific reports, and articles, but also the adaptation of official normative documents for the military personnel protection from mass destruction weapons, technical and medical means of individual, and collective protection.

The development and experimental assessment of medical devices protecting eviscerated abdominal organs using the eventration model

On an experimental model of eventration in small and large animals (94 rats and 12 pigs), the safety and effectiveness of samples of aseptic protective dressings made of nanomaterials with impregnations used to prevent the development of complications from abdominal organs and tissues in comparison with control ones gauze medical sterile ones were evaluated. After 3 hours, 3 and 7 days after surgery, the viability of the intestinal wall and the presence of complications were assessed on the basis of laboratory, experimental, instrumental and morphological techniques. The assessment of microcirculation (perfusion) of the intestine was carried out using the apparatus LAKK-02. It was found that according to the complex of clinical and laboratory, microbiological, morphological, microcirculatory data and expert assessment, the safest and most effective for the protection of abdominal organs was an aseptic bandage made of non-woven material spunbond impregnated with vinylin + silicone. The initial values of microcirculation parameters in the pig groups were: 18.4 [17.1; 19] perfusion units in the experimental group and 15.6 [6.8; 17.7] perfusion units in the control group. After applying the bandage in the experimental group, the level of microcirculation did not significantly change. In the control group, after 3-hour exposure to the bandage, a decrease in the level of microcirculation was observed to 6.5 [5.1; 8] perfusion units (p 0.05 compared to the initial and similar stage in the experimental group). Thus, an aseptic bandage made of spunbond nanomaterial impregnated with vinylin + silicone retains the necessary moisture and protects the eventrated abdominal organs, demonstrates safe adhesive properties and prevents the development of local and general complications in the early postoperative period.

Development of mine-blast trauma severity score for lower extremities in men

This study presented the results of the analysis of existing approaches to the assessment of the severity of lower extremity injuries protected with explosion-proof shoes in case of mine-explosive ammunition explosion. An increasing number of mine explosives are used in modern local wars and armed conflicts. At present, more than 110 million mines are planted and activated. Every year, nearly 10 thousand individuals are killed by explosive demolitions, and more than 20 thousand civilians sustain injuries. The necessity to clear minefields and to destroy located ammunition increases the risks of mine clearance specialists to mine-blast trauma of the lower extremities. To reduce the likelihood of severe trauma in this population, developing effective blast protective equipment, such as anti-mine boots, is necessary. The effectiveness evaluation of protective boots requires special methodology that should comprise relevant methods of mine-blast trauma severity estimation. Mine-blast trauma is a special type of surgical pathology where the injured individual has extremity avulsion or multiple injuries to extremity tissues accompanied by severe impairment of body functions. Almost all available domestic classifications of mine-explosive wounds have a pronounced clinical orientation, and foreign ones have terminologies that are not accepted in Russia and cannot be fully used for assessment purposes. The modified working classification, in the form of a rating scale, showed not only the characteristics of a given blast trauma but also the criteria of trauma severity estimation and feasibility of exposure to blast trauma. The results of the study demonstrated the potential for its use to estimate the protective features of mine clearance specialist boots when exposed to charge explosion, as well as recommendations to include this classification in documenting the science and technology that deal with the general specifications of protective equipment for specialists at the project stage.