Diagnostic and Treatment Errors in Biliary Cystadenomas and Cystadenocarcinomas: Clinical Cases

Background. Biliary cystadenomas and cystadenocarcinomas are rare cystic tumors of the liver. Complicated differential diagnostics for simple cysts often leads to errors in surveillance of patients with these tumors. Cystadenoma and cystadenocarcinoma should be suspected upon detection of single or multilocular cystic neoplasms of the liver with septa and blood flow loci  in the cyst wall, especially in middle-aged women. The localization of the tumor is critical. The most common localization is segment IV of the liver. Urgent intraoperative biopsy is required to determine the extent of surgery.Case description. Clinical observations with analysis of the examination and treatment data of two female patients aged 38 and 56 were presented. Both clinical observations illustrate the underestimation of the preoperative examination data that served as a ground for diagnosis of liver cysts with inadequate extent of surgery. In the first case, the resection was incomplete, and, as such, the biliary cystadenoma recurred in the resection area, the capsule of the neoplasm was ruptured and an encysted fluid collection was formed. In the second case, lack of histological examination of the excised neoplasm, due to confidence in its morphological verification as a cyst, resulted in cystadenoma recurrence in the resection zone with metastasis to the contralateral lobe of the liver.Conclusion. Hepatic cystadenomas and cystadenocarcinomas are often misdiagnosed as simple cysts. These tumors should be suspected in central localization of the tumor in the liver, especially in young women. The clinical and instrumental symptomatology and radiological semiotics of the disease require careful evaluation. The recurrence of a cystic lesion in the resection zone in a patient previously operated for a hepatic cyst serves as an additional signal for detecting biliary cystadenoma. Rational strategy for surgical management of cystic liver lesions should include hepatectomy within healthy tissues (both anatomical and atypical) with mandatory intraoperative ultrasound and urgent histological examinations

Метастазы в поджелудочной железе: лучевые методы оценки криодеструкции

Metastases in the pancreas are rather rare tumor lesion of this organ. According to different data, the incidence of metastatic pancreatic lesions varies from 1.8 to 4% of all pancreatictumors.The article presents three clinical observations of metastases of melanoma, renal clearcell cancer, lung cancer in the pancreas. All patients were treatedusing cryosurgical methods with positive dynamics in the postoperative period.A brief review of the literature discussing metastatic lesions of the pancreas is also done, and the management treatment tactics of these patients is described. Метастазы в поджелудочной железе – достаточно редко встречающееся опухолевое поражение этого органа. Согласно литературным данным, доля метастазов среди злокачественных опухолей поджелудочной железы варьирует от 1,8 до 4%.В статье представлены три клинических наблюдения метастазов опухолей в поджелудочной железе – метастазов меланомы, светлоклеточного рака почки, рака легкого. Все пациенты были оперированы с использованием методов криохирургического воздействия с положительной динамикой в послеоперационном периоде наблюдения.Также приведен краткий обзор литературы по проблеме метастатического поражения поджелудочной железы и предложена тактика ведения таких пациентов.

Распространенное альвеококковое поражение печени с вовлечением нижней полой вены (клиническое наблюдение)

Among parasitic diseases, liver alveococcosis is a particular complication. It is often compared with parasitic liver cancer, due to infiltrative growth, the possibility of metastasis, as well as the high frequency of relapse after surgical treatment. However, the main difference between the course of alveococcosis liver damage is a slow infiltrative growth, which, in combination with large compensatory capacities of the hepatic tissue, often leads to the fact that the clinical manifestations of the disease occur late, even with a significant spread of the pathological process, at the stage of complications. At the same time, complete operative re moval of the tumor remains the only radical treatment for such patients. We present the clinical case of the diagnosis and multistage treatment of the patient E., 57 years old, with the widespread liver alveococcosis involving the inferior vena cava.Среди паразитарных заболеваний особую сложность представляет альвеококкоз печени. Его нередко сравнивают с паразитарным раком печени по причине инфильтративного роста, возможности метастазирования, а также высокой частоты рецидивов после оперативного лечения. Однако основным отличием течения альеококкового поражения печени является медленный инфильтративный рост, что в сочетании с большими компенсаторными способностями печеночной ткани зачастую приводит к тому, что клинические проявления заболевания возникают поздно, уже при значительном распространении патологического процесса, на стадии присоединения осложнений. При этом полное оперативное удаление опухоли остается единственным радикальным методом лечения таких пациентов. Представляем клиническое наблюдение диагностики и многоэтапного лечения пациентки Е., 57 лет, с распространенным альвеококкозом печени с вовлечением нижней полой вены

Solvent and spectral effects in the ultrafast charge recombination dynamics of excited donor-acceptor complexes

The charge recombination dynamics of excited donor-acceptor complexes consisting of hexamethylbenzene (HMB), pentamethylbenzene (PMB), and isodurene (IDU) as electron donors and tetracyanoethylene (TCNE) as electron acceptor in various polar solvents has been investigated within the framework of the stochastic approach. The model accounts for the reorganization of intramolecular high-frequency vibrational modes as well as for the solvent reorganization. All electron-transfer energetic parameters have been determined from the resonance Raman data and from the analysis of the stationary charge transfer absorption band, while the electronic coupling has been obtained from the fit to the charge recombination dynamics in one solvent. It appears that nearly 100 % of the initially excited donor-acceptor complexes recombine in a nonthermal (hot) stage when the nonequilibrium wave packet passes through a number of term crossings corresponding to transitions toward vibrational excited states of the electronic ground state. Once all parameters of the model have been obtained, the influence of the dynamic solvent properties (solvent effect) and of the carrier frequency of the excitation pulse (spectral effect) on the charge recombination dynamics have been explored. The main conclusions are (i) the model provides a globally satisfactory description for the IDU/TCNE complex although it noticeably overestimates the spectral effect, (ii) the solvent effect is quantitatively well described for the PMB/TCNE and HMB/TCNE complexes but the model fails to reproduce their spectral effects, and (iii) the positive spectral effect observed with the HMB/TCNE complex cannot be described within the framework of two-level models and the charge redistribution in the excited complexes should most probably be taken into account. I