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PubMed | Latisana Palmanova Hospital, Hebrew University of Jerusalem, University of Barcelona, Ospedale San Luigi Gonzaga and 13 more.
Type: | Journal: Surgical endoscopy | Year: 2016

Single-port laparoscopic surgery as an alternative to conventional laparoscopic cholecystectomy for benign disease has not yet been accepted as a standard procedure. The aim of the multi-port versus single-port cholecystectomy trial was to compare morbidity rates after single-access (SPC) and standard laparoscopy (MPC).This non-inferiority phase 3 trial was conducted at 20 hospital surgical departments in six countries. At each centre, patients were randomly assigned to undergo either SPC or MPC. The primary outcome was overall morbidity within 60days after surgery. Analysis was by intention to treat. The study was registered with ClinicalTrials.gov (NCT01104727).The study was conducted between April 2011 and May 2015. A total of 600 patients were randomly assigned to receive either SPC (n=297) or MPC (n=303) and were eligible for data analysis. Postsurgical complications within 60days were recorded in 13 patients (4.7%) in the SPC group and in 16 (6.1%) in the MPC group (P=0.468); however, single-access procedures took longer [70min (range 25-265) vs. 55min (range 22-185); P<0.001]. There were no significant differences in hospital length of stay or pain VAS scores between the two groups. An incisional hernia developed within 1year in six patients in the SPC group and in three in the MPC group (P=0.331). Patients were more satisfied with aesthetic results after SPC, whereas surgeons rated the aesthetic results higher after MPC. No difference in quality of life scores, as measured by the gastrointestinal quality of life index at 60days after surgery, was observed between the two groups.In selected patients undergoing cholecystectomy for benign gallbladder disease, SPC is non-inferior to MPC in terms of safety but it entails a longer operative time. Possible concerns about a higher risk of incisional hernia following SPC do not appear to be justified. Patient satisfaction with aesthetic results was greater after SPC than after MPC.


PubMed | Russian Academy of Sciences, Ural Federal University, Sverdlovsk Regional Clinical Hospital No 1 and Av Vishnevsky Institute Of Surgery
Type: Journal Article | Journal: Bulletin of experimental biology and medicine | Year: 2016

We revealed some features of the left ventricular functional geometry in patients with myocardial diseases with different degrees of left ventricular systolic dysfunction. A negative correlation was found between the spatio-temporal heterogeneity of the kinetics of the left ventricular wall during systole and ejection fraction in normal heart and in systolic dysfunction. The differences in the quantitative characteristics of the functional geometry between patients and normal subjects and between different groups of patients depended on the severityof left-ventricular systolic dysfunction. In particular, spatial heterogeneity index that characterizes heterogeneity of systolic movement of the wall segments and end-systolic Fourier shape-power index characterizing complexity of the left ventricle shape during systole differed significantly in the examined groups of patients and have the greatest diagnostic power.


Starkov Y.G.,Av Vishnevsky Institute Of Surgery | Solodinina E.N.,Av Vishnevsky Institute Of Surgery | Zamolodchikov R.D.,Av Vishnevsky Institute Of Surgery
Khirurgiia | Year: 2016

MATERIAL AND METHODS: Endosonography-assisted internal drainage of pancreatic pseudocysts was performed in 25 patients. Plastic stents were implanted in one stage without change of instruments while metal stents - with change of instruments during manipulation.RESULTS: Intervention was successful in 24 patients. In 1 case bleeding developed during cystostomy that required open surgery. Plastic and metal stents were used in 11 and 12 patients respectively. 1 patient had two pancreatic pseudocysts. Therefore 2 stents of both types were used in this case. Clinical success was achieved in 91% of cases.AIM: To present own experience of internal drainage and characteristics of its different variants which are applied in various countries.CONCLUSION: Different variants of method resolve problem of surgical approach, stomy and choice of stent. However every technique is targeted to resolve separate problem while single method is not accepted. Further large comparative studies are necessary to define optimal technique of internal drainage.Abstract available from the publisher.


Pokrovskii A.V.,Av Vishnevsky Institute Of Surgery
Angiologii{combining double inverted breve}a i sosudistai{combining double inverted breve}a khirurgii{combining double inverted breve}a = Angiology and vascular surgery | Year: 2012

to study remote results of surgical treatment of patients presenting with a pathological deformity of the internal carotid artery. the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (ICA), who underwent a total of 166 reconstructive operations. 7% of patients were operated on at the asymptomatic stage, more than half (56%) of the patients were found to have transient (21%) or persistent neurological deficit (35%), 37% of patients had stage III cerebrovascular insufficiency. Twenty-five (15%) operations were performed for C- and S-shape tortuosity, ninety-seven (58%) procedures for kinking of the internal carotid artery, and forty-four (27%) interventions for coiling. The operation of choice was resection with redressation of the internal carotid artery and reimplantation into the old ostium (74%). Analysing the results of surgical treatment showed its high neurological efficiency in prevention of cerebral circulation impairments (93% of patients at terms up to 25 years had no such complications), as well as clinical efficacy (relief of cerebrovascular insufficiency symptoms in 91.1% of patients). The effect obtained appeared to preserve during 2 and 5 years in 96% and 92% of patients, respectively, and at terms up to 25 years in 83%. The 3-, 5- and up- to-25-year survival amounted to 95%, 92% and 75%, respectively. Restenosis of the internal carotid artery was significantly more often observed after prosthetic repair of the artery (p <0.05) as compared with other methods of reconstruction employed. Thromboses of the internal carotid artery were encountered with similar frequency (8%) only after prosthetic repair and resection of the internal carotid artery with an «end-to-end» anastomosis, which was significantly more often than in resection with redressation (p <0.05). Stroke incidence in the remote postoperative period amounted to 0.8% and the «stroke + stroke-related mortality» parameter equalled 1.6%. the remote results of surgical treatment for pathological deformity of the internal carotid artery are strongly suggestive of high efficacy of this method of prevention of impairments of cerebral circulation and treatment of cerebrovascular insufficiency in patients with the pathology concerned. The operation of choice in pathological deformity of the internal carotid artery is resection with redressation of the internal carotid artery and reimplantation into the original ostium.


PubMed | Sloan Kettering Cancer Center, Moscow State University, Sp Botkin City Clinical Hospital and Av Vishnevsky Institute Of Surgery
Type: Journal Article | Journal: Clinical radiology | Year: 2016

To identify the multidetector computed tomography (MDCT) features of pancreatic neuroendocrine tumours (pNETs), which correlate with tumour histology and enable preoperative grading.Thirty-nine patients with histologically confirmed pNET who underwent preoperative contrast-enhanced MDCT were included in this study. Nineteen tumours were classified as Grade 1 (G1) and 20 as Grade 2 (G2). Histopathology slides were reviewed to assess the intratumoural microvascular density (MVD) and the amount of tumour stroma. Computed tomography (CT) image analysis included tumour size, margin delineation, calcifications, homogeneity, contrast enhancement (CE) pattern, tumour absolute and relative enhancement, presence of cystic changes, pancreatic duct dilatation, regional and distant metastases. The diagnostic ability to predict tumour grade was measured for each MDCT finding and their combinations.The mean arterial enhancement ratio had a meanstandard deviation of 1.530.45 in G1 and 1.010.33 in G2 pNETs (p=0.0003) and correlated with intratumoural microvascular density (MVD; r=0.55, p=0.0002). Tissue stroma percentage did not correlate with imaging findings. Late CE of the tumour (the peak attenuation observed in the venous phase) was significantly associated with G2. Tumour size >20 mm, arterial enhancement ratio <1.1, and late CE showed 74.4%, 79.5%, and 74.4% accuracy, respectively, in diagnosing G2 tumours, while the accuracy of at least two of these criteria used in combination was 82%. Based on these results, a diagnostic algorithm was proposed, which showed high interobserver agreement (k=0.82) in the prediction of tumour grade.Contrast-enhanced MDCT features correlate with histological findings and enable the differentiation between G1 and G2 pNETs during preoperative examination.


PubMed | Av Vishnevsky Institute Of Surgery
Type: | Journal: Khirurgiia | Year: 2016

To optimize the diagnosis and surgical treatment of insulinoma and nesidioblastosis.42 patients with organic hyperinsulinism (OH) were operated. There were 39 cases of insulinoma including 2 patients with insulinoma combined with nesidioblastosis and 3 cases of nesidioblastosis alone. Preoperative ray imaging consisted of percutaneous, endoscopic and intraoperative sonography, contrast-enhanced computed tomography, magnetic resonance imaging (MRI). Functional test included arterial-stimulated blood sampling (ASBS). Laparotomy and robot-assisted techniques were used in 22 and 20 patients.Sensitivity was 62.0%, 76.9%, 83.3%, 87.5%, 94.8% and 100% in percutaneous sonography, CT, endoscopic sonography, MRI, intraoperative sonography and ASBS respectively. Postoperative complications were observed in 14 and 6 patients after conventional and robot-assisted surgery. 2 patients died. Overall mortality was 4.8%. None patient had recurrent hypoglycemic conditions in long-term postoperative period (mean follow-up 18.7 months).Comprehensive survey allowed to define the cause of OH. Minimally invasive organ-sparing surgery has satisfactory immediate and remote results in these patients.


PubMed | National Medical Research Radiological Center, RAS Engelhardt Institute of Molecular Biology and Av Vishnevsky Institute Of Surgery
Type: Journal Article | Journal: Oncotarget | Year: 2016

Aging and cancer are the most important issues to research. The population in the world is growing older, and the incidence of cancer increases with age. There is no doubt about the linkage between aging and cancer. However, the molecular mechanisms underlying this association are still unknown. Several lines of evidence suggest that the oxidative stress as a cause and/or consequence of the mitochondrial dysfunction is one of the main drivers of these processes. Increasing ROS levels and products of the oxidative stress, which occur in aging and age-related disorders, were also found in cancer. This review focuses on the similarities between ageing-associated and cancer-associated oxidative stress and mitochondrial dysfunction as their common phenotype.


PubMed | Ryazan State Medical University, Av Vishnevsky Institute Of Surgery and Russian Society of Surgeons.
Type: | Journal: Khirurgiia | Year: 2016

To examine the work of surgical service in the Central Federal District and to define the main directions to improve the efficacy of surgical care in case of acute abdominal diseases.The results of surgical service of the Central Federal District for the period 2011-2014 in treatment of 2.5 millions patients were analyzed.Parameters in elective and emergency surgery persuasively prove stable work of surgical service of the Central Federal District for recent years. Obtained results were compared with the indicators of emergency surgical care in Moscow for objective assessment. It was revealed 2-4-fold decrease of overall and postoperative mortality in Moscow.Conditions for all-day diagnostic and medical assistance for emergency abdominal diseases should be created to improve the effectiveness of surgical service of the Central Federal District.


PubMed | Av Vishnevsky Institute Of Surgery
Type: | Journal: Khirurgiia | Year: 2016

To create multidisciplinary diagnostic and curative approach to patients with intestinal fistulae.Additional nutritive support was applied in all patients preoperatively. 35 patients with intestinal fistulae were operated. Unformed and formed intestinal fistulae were observed in 10 and 25 patients respectively. Radical one-stage surgery was performed in 30 cases, two-stage - in 3 patients. Unformed fistulae opened into granulating wound were not eliminated in 2 patients.Postoperative complications were observed in 10 patients. 2 of them required re-intervention. There were no deaths.


PubMed | Av Vishnevsky Institute Of Surgery
Type: | Journal: Khirurgiia | Year: 2016

To present own experience of internal drainage and characteristics of its different variants which are applied in various countries.Endosonography-assisted internal drainage of pancreatic pseudocysts was performed in 25 patients. Plastic stents were implanted in one stage without change of instruments while metal stents - with change of instruments during manipulation.Intervention was successful in 24 patients. In 1 case bleeding developed during cystostomy that required open surgery. Plastic and metal stents were used in 11 and 12 patients respectively. 1 patient had two pancreatic pseudocysts. Therefore 2 stents of both types were used in this case. Clinical success was achieved in 91% of cases.Different variants of method resolve problem of surgical approach, stomy and choice of stent. However every technique is targeted to resolve separate problem while single method is not accepted. Further large comparative studies are necessary to define optimal technique of internal drainage.

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