Reconstructive interventions in thoracic surgery using titanium nickelide implants

The original techniques of bronchus stump closure, modeling and disjunction of non-neoplastic tracheoesophageal fistula, replacement of postresectional defects of the trachea, pericardium, diaphragm and the thoracic wall using titanium nickelide implants have been developed and tested. It was ascertained that these methods were highly effective and simplified and standardized surgical procedures, provided anatomic and physiologic reconstruction of the injured area

NEW TECHNOLOGIES iN RECONSTRUCTIVE SURGERY OF INJURIES AND CICATRICIAL STENOSES OF TRACHEA

The results of treatment of 9 patients with mechanical injury of trachea and of 22 patients with cicatricial stenoses of trachea are presented, in this article. 18 patients had. staged, reconstructive and plastic operations at the cicatricial stenosis, 2 patients had. endoscopic recanalization of tracheal lumen and. 2 patients had. sleeve resection of trachea with, anastomosis. An. original medical complex including argon-plasmatic, cryosurgical and. lymphotropic technologies. In all cases we managed, to recover respiratory tract integrity and. to provide adequate breath through, natural respiratory tract

Радикальная нефрэктомия по поводу почечно-клеточного рака и замещение сегмента нижней полой вены ксеноперикардиальным трансплантатом

Vascular repairs in oncology practice improve quality of life and survival in patients. There is tumor involvement of the inferior vena cava (IVC) and complete removal of its segment followed by repair and the removed IVC portion may be replaced with auto-, allogeneic, and xenogeneic grafts. The purpose of the replacement is to recover adequate venous drainage if acute IVC occlusion develops intraoperatively. The paper describes a case of successful treatment in a 61-year-old female patient with an occasionally detected large right kidney tumor and intraoperative signs of IVC invasion. Radical surgery was performed resecting an IVC fragment and replacing it with a tubularized xenopericardial graft without repairing the ostium of the left renal vein. The postoperative period was uncomplicated. The patient was discharged in satisfactory condition; targeted therapy was recommended. At 6-month follow-up, there were neither signs of tumor progression nor IVC occlusion.Проведение сосудистых реконструкций в онкологической практике повышает качество и продолжительность жизни больных. Поражение нижней полой вены (НПВ) опухолевым процессом и полное удаление сегмента с последующей реконструкцией с заменой удаленного участка НПВ аутологичными, аллогенными и ксеногенными трансплантатами. Цель замещения – восстановление адекватного венозного дренажа в случаях развития острой окклюзии НПВ во время оперативного вмешательства. Представлен случай успешного лечения больной, 61 года, со случайно обнаруженной опухолью правой почки больших размеров, с установленными во время операции признаками инвазии НПВ. Выполнена радикальная операция с резекцией фрагмента НПВ и его замещением тубуляризированным ксеноперикардиальным транплантатом без реконструкции устья левой почечной вены. Послеоперационный период без осложнений. Больная выписана в удовлетворительном состоянии, назначена таргетная терапия. Через 6 мес наблюдения признаков прогрессирования опухолевого процесса не определяется, нет нарушения проходимости НПВ

Результаты тазовой экзентерации у женщин, выполненной по поводу опухолевых поражений и осложнений лучевой терапии

This investigation was conducted in women with small pelvic involvements. Thirty-five case reports were analyzed; treatment results were known in 33 (94.3 %) patients. The patients» age was 55.9 (34-82) years. According to the source of the pathological process, there were 3 patient groups: gynecological, urological, and colorectal. The basic surgical procedure was anterior or total pelvic exenteration. The specific features of all cases were locally advanced tumors, recurrences, and complications due to performed treatment (radiotherapy) for cancer of the cervix uteri. Surgical treatment was feasible in all cases; in this case bleeding was arrested, pain syndrome was relieved, and urination and defecation control was restored. Проведенное исследование касалось женщин с поражением органов малого таза. Анализу подвергнуты 35 историй болезни, результат лечения известен о 33 (94,3 %) пациентках. Возраст пациенток составил 55,9 (34–82) года. В зависимости от источника патологического процесса выделены 3 группы пациенток – гинекологические, урологические, колоректальные. Основными видами операции были передняя или тотальная тазовая экзентерация. Особенностями всех случаев являлись местно-распространенные опухоли, рецидивные состояния, осложнения проведенного лечения (лучевой терапии) по поводу рака шейки матки. Во всех случаях хирургическое лечение было выполнимо, при этом у всех больных устраняли кровотечение, болевой синдром, восстанавливали контроль за выделением мочи и кала.

Случай лечения пациент а с синхронным дв усторонним почечно-клеточным раком и одновременным метастатическим поражением обоих надпочечников. Клиническое наблюдение

Synchronous bilateral renal cell carcinoma occurs in 1.4 % of cases. The probability of bilateral adrenal metastases from renal cell carcinoma is less than 0.5 %. The clinical observation presents a case of synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands. A 55‑year-old male patient was adm tted with the signs of hematuria and anemia to the Unit of Urology, Clinic of General Surgery, Siberian State Medical University. He was found to have synchronous bilateral renal cell carcinoma and simultaneous bilateral adrenal involvement. Sequential surgical treatment – radical nephrectomy (with adrenal gland removal) on the right side and, after 3 months, adrenalectomy and kidney resection on the left side were performed. All the organs removed displayed tumors that proved to be renal cell carcinomas (a clear cell variant). There were lymph node metastases in the right-sided renal portal. Postoperatively, the investigators performed hormone replacement therapy for adrenal insufficiency, an immunotherapy cycle, three cycles of targeted therapy withsorafenib and sunitinib (at an interval of 0.5–2 years), and insulin therapy for new-onset diabetes mellitus. The duration of a follow-up was 6.2 years. When describing the case, the patient was alive and showed a generalized tumorous process with extensive tumor involvement of the solitary kidney. Sunitinib therapy was used.Двусторонний синхронный рак почки (РП) встречается в 1,4 % случаев. Вероятность двустороннего метастазирования в надпочечники при РП составляет менее 0,5 %. В клиническом наблюдении представлен случай двустороннего синхронного РП и одновременного метастатического поражения обоих надпочечников. Пациент 55 лет госпитализирован в урологическое отделение клиники общей хирургии СибГМУ с явлениями гематурии и анемии. Выявлен синхронный двусторонний РП с одновременным двусторонним поражением надпочечников. Проведено последовательное хирургическое лечение: радикальная нефрэктомия (с удалением надпочечника) справа, через 3 мес – адреналэктомия и резекция почки слева. Во всех удаленных органах опухоль имеет строение почечно-клеточного рака (ПКР), светлоклеточный вариант. Справа – метастатическое поражение лимфатических узлов ворот почки. В послеоперационном периоде – заместительная гормональная терапия надпочечниковой недостаточности,курс иммунотерапии, 3 курса таргетной терапии препаратами сорафениб и сунитиниб (с интервалом 0,5–2 года), инсулинотерапия по поводу впервые выявленного сахарного диабета. Длительность наблюдения составила 6,2 года. К моменту описания наблюдения пациент жив, генерализация опухолевого процесса с обширным опухолевым поражением единственной почки. Назначена терапия сунитинибом

Stimulation of Liver Regeneration Using a Titanium Nickelide Implant (Experimental Study)

Currently, morbidity and mortality from chronic diffuse diseases of the liver and cirrhosis continue to increase worldwide. The difficulty of stabilizing the process with pharmacological agents, lots of restrictions for liver transplantation, the palliative character of the surgical correction of complications determine the urgency of finding various ways to stimulate liver regeneration, including surgical ones. Most of the known methods of surgical stimulation of regeneration are quite traumatic, and their stimulating effect is short-lived. The methods associated with cellular technologies are mostly expensive, ineffective, or poorly understood. In the experimental study, the effect on the parenchyma of a healthy and cirrhotic liver clips for clamping parenchymal organs exerting different unit pressure on the tissue was studied. The object of the study was laboratory rats with a healthy liver and animals with simulated cirrhosis. The animals were operated on with the imposition of titanium nickelide clips on the liver. Changes in the liver were studied 3, 7, 14, and 28 days after the surgery by histological examination of various parts of the liver. It was established that the clip with a lower specific pressure did not cause tissue necrosis, led to atrophy of the marginal part of the liver, also increased hepatocytes and binuclear hepatocytes were observed in the bulk of the liver. A decrease in the proportion of connective tissue was also observed in groups with liver cirrhosis. Thus, we consider it possible to use clips with a certain specific pressure on the tissue as a method of stimulating the reparative properties of the liver in chronic diffuse diseases and cirrhosis of the live

МЕТОДИКА ЛОКАЛЬНОЙ ОРГАНОСОХРАНЯЮЩЕЙ КРИОДЕСТРУКЦИИ НАДПОЧЕЧНИКОВ. ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ

A method of local adrenal organ-preserving cryolysis using a porous nickelide titanium cryoprobe created for this purpose was developed in experiments in 14 dogs. The efficacy of the method was demonstrated by the morphological evidence and hormone tests.В экспериментах на 14 собаках разработана методика локальной органосохраняющей криодеструкции надпочечника с помощью созданного криоаппликатора из пористого никелида титана. Эффективность методики доказана морфологически и результатами исследования гормонов

Radical nephrectomy for renal cell carcinoma and replacement of an inferior vena cava segment with a xenopericardial graft

Vascular repairs in oncology practice improve quality of life and survival in patients. There is tumor involvement of the inferior vena cava (IVC) and complete removal of its segment followed by repair and the removed IVC portion may be replaced with auto-, allogeneic, and xenogeneic grafts. The purpose of the replacement is to recover adequate venous drainage if acute IVC occlusion develops intraoperatively. The paper describes a case of successful treatment in a 61-year-old female patient with an occasionally detected large right kidney tumor and intraoperative signs of IVC invasion. Radical surgery was performed resecting an IVC fragment and replacing it with a tubularized xenopericardial graft without repairing the ostium of the left renal vein. The postoperative period was uncomplicated. The patient was discharged in satisfactory condition; targeted therapy was recommended. At 6-month follow-up, there were neither signs of tumor progression nor IVC occlusion