Успешные клинические случаи реконструктивно пластических лапароскопических операций на мочеточнике трансплантированной почки

Treatment of ureteral strictures in the long-term post-transplant period is a complex surgical procedure. We present successful clinical cases of developed laparoscopic ureteral stricture reconstruction methods at three levels (in the pelvis, along the ureter, in the anastomosis area). These methods have shown their clinical efficacy: they are less traumatic, there are no adverse events in the early and long-term postoperative periods, and there is accelerated rehabilitation of recipients after surgery.Лечение стриктур мочеточника в отдаленном посттрансплантационном периоде является сложной хирургической задачей. Представлены успешные клинические случаи применения разработанных реконструктивно-пластических лапароскопических методов коррекции стриктуры мочеточника на трех уровнях (в области лоханки, на протяжении мочеточника, в области анастомоза), показавшие свою клиническую эффективность: менее травматичны, без нежелательных событий в раннем и отдаленном послеоперационных периодах, ускоренная реабилитация реципиентов после операции

PATHOLOGICAL FRACTURE OF THE SPINE IN A PATIENT WITH ANKYLOSING SPONDYLITIS: DIFFICULTIES OF RADIOLOGICAL DIAGNOSIS

We present a clinical observation of a pathological fracture of the spine in a patient with ankylosing spondylitis (Bechterew's disease). The results of a comprehensive radiological assessment (X-ray, multidetector computed tomography, magnetic resonance imaging), which enabled the differential diagnosis with a tumor and inflammatory processes and to determine a management strategy

Using the arterial spins labeling method (ASL-perfusion) for evaluation of glioblastoma residual tissue

Objective. To evaluate the efficiency of ASL-perfusion as a method of estimating of hemodynamics and detection of residual tumor tissue after surgical treatment of glioblastoma.Material and methods. 56 patients after brain tumor’s surgical resection of glioblastoma (GRADE IV). CBF values were determined in 3 different areas - in the presumed tumor tissue with maximum perfusion, in the postoperative scar tissue and in the deep white matter of the opposite hemisphere. All patients were divided into 2 groups according to CBF value.Results. 1st group: 38 (67.9%) patients - the average CBF in suspected tumor was 137.6±35.2 (79.6-227.6) ml/100 g/min. It was 6-8 times higher than CBF in the deep white matter of the opposite hemisphere, and 5-6 times higher than in the postoperative scars.2nd group: 18 (32.1%) patients with no pathological elevation of CBF in postoperative scar tissue. CBF there was 22.3±5.9 (13.9-37.1) ml/100 g/min. CBF in white matter in the contralateral hemisphere was similar.There was no significant differences in CBF of scar tissue (p=0,52) and in white matter of contralateral hemisphere (p=0,96) in both groups.Conclusion. The possibilities of ASL-perfusion are enough to estimating of hemodynamics and detection of residual tumor tissue after surgical removed glioblastoma

Technique of the laparoscopic pelvic exenteration

Background: Laparoscopic surgery has proved itself to be a “golden standard” for treatment of most abdominal and retroperitoneal cancers. Such a serious procedure as pelvic exenteration continues to be a complex surgical intervention usually performed through a  conventional laparotomic access. However, studies on minimally invasive approach for this intervention have becoming increasingly published in the world literature.Aim: To describe the laparoscopic pelvic exenteration technique of pelvic exenteration, as well as to assess short- and long-term results of these interventions.Materials and methods: From 2011 to 2018, 21 procedures of laparoscopic pelvic exenteration have been performed in 6  surgical centers (Moscow, Russia). Six (6) patients had previously confirmed cervical cancer, 7 patients had bladder cancer, 4 patients had rectal cancer, 1 patient had vaginal cancer, 2 patients had relapsing vaginal cancers after previous uterine extirpation, and 1 patient had an ovarian neoplasm.Results: The laparoscopic pelvic exenteration volumes were as follows: 9  total, 7 anterior and 5 posterior procedures. In 19 out of 21 cases, negative resection margin (R0) was possible. Median duration of the procedure was 254 minutes, median blood loss was 515 ml, and median postoperative hospital stay was 13 days. Postoperative complications were registered in 6 (28.6%) patients. The 3-year overall survival was 85.71%.Сonclusion: The choice of laparoscopic access can reduce blood loss, decrease the rates of early postoperative complications, contributes to a more comfortable postoperative period with early activation and less severe pain syndrome, and leads to a reduction in the duration of hospital stay. These results of the laparoscopic technique are comparable with those of laparoscopic and open pelvic exenteration published by other authors