Av Vishnevsky Institute Of Surgery

Av Vishnevsky Institute Of Surgery

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Rusakov I.G.,Moscow State University | Teplov A.A.,Av Vishnevsky Institute Of Surgery | Uljanov R.V.,Pa Herzen Mcri Branch Of Fsbi Nmrrc Of The Ministry Of Health Of The Russian Federation | Filonenko E.V.,Moscow State University
Biomedical Photonics | Year: 2015

The main challenge of treating non-muscle invasive bladder cancer is multifocal tumors. Current methods of diagnosis are failed to detect all superficial flat tumor lesions in bladder mucosa. The use of fluorescence imaging with 5-aminolevulinic acid (5-ALA) allows to improve the sensibility of routine cystoscopy, but low specificity decreases its diagnostic accuracy. The method of fluorescence imaging combined with local fluorescence spectroscopy developed in P.A. Herzen MCRI has been shown to increase the specificity from 71% to 84%. Thus, local fluorescence spectroscopy in visible fluorescence of 5-ALA-induced protoporphyrin allows to perform guided biopsy and decrease the rate of diagnostic mistakes.


Zharikov Y.O.,Av Vishnevsky Institute Of Surgery | Kovalenko Y.A.,Av Vishnevsky Institute Of Surgery | Olifir A.A.,Av Vishnevsky Institute Of Surgery | Kalinin D.V.,Av Vishnevsky Institute Of Surgery | Czhao A.V.,Av Vishnevsky Institute Of Surgery
Khirurgiia | Year: 2017

INTRODUCTION: The objective of this study was to derive a prognostic scale to predict overall survival (OS) after a curative resection of perihilar cholangiocarcinoma (PHC).MATERIAL AND METHODS: The data of 55 patients with portal cholangiocarcinoma were analysed. Patients were treated at the A.V. Vishnevsky Institute of Surgery from 2011 to 2015. Surgical treatment after biliary decompression was performed in 37 (67.3%) patients. In the long-term period we observed 36 (97.3%) of the operated patients. The dependence of the OS of clinical and pathological factors of the tumor was analysed using mono- and multifactor regression analysis of Cox proportional hazards models for all operated patients.RESULTS: Total 1-3-, 5-year survival rate was 75.1, 60.5, 37.7, 35% respectively. Significant prognostic factors (monofactorial analysis) include perineural (p=0,05) and vascular invasion (p=0,049), R1 resection (p=0,01), disease stage III or higher (p=0,03), invasion of SI liver (p=0,004), tumor cells differentiation degree (grade) 2 and higher (p=0,0006). Multifactor analysis revealed that the low OS have determined by perineural (p=0,05) and vascular invasion (p=0,008), the degree of differentiation of tumor cells (p=0,001), disease stage (p=0,05), surgical resection margin (p=0.0345). Developed method of predicting OS is a score of prognostic factors.CONCLUSION: The scale of individual prognosis in patients PHC takes into account both clinical and histopathological tumor characteristics. This scale may be useful to optimize the individual treatment.Введение. Разработан способ прогнозирования общей выживаемости у больных воротной холангиокарциномой, перенесших хирургическое вмешательство, в основу которого положены значимые клинико-патологические факторы опухоли. Материал и методы. В анализ включены 55 пациентов с воротной холангиокарциномой, проходивших лечение с 2011 по 2015 г. в Институте хирургии им. А.В.Вишневского. Хирургическое лечение после билиарной декомпрессии было проведено у 37 (67,3%) больных. В отдаленные сроки наблюдались 36 (97,3%) оперированных больных. Проанализирована зависимость общей продолжительности жизни от клинико-патологических факторов опухоли с помощью моно- и полифакторного анализа регрессионной модели пропорционального риска Кокса у всех оперированных больных. Результаты. Общая 1—3-, 5-летняя выживаемость составила 75,1, 60,5, 37,7, 35% соответственно. При монофакторном анализе значимыми прогностическими факторами являются периневральная (p=0,05) и сосудистая инвазия (р=0,049), R1 резекция (p=0,01), стадия заболевания III и выше (p=0,03), инвазия в SI печени (p=0,004), степень дифференцировки клеток опухоли (grade) 2 и выше (p=0,0006). При полифакторном анализе было выявлено, что низкую общую выживаемость обусловливали: периневральная (p = 0,05) и сосудистая инвазия (p=0,008), степень дифференцировки клеток опухоли (p=0,001), стадия заболевания (p=0,05), хирургический край резекции (р=0,0345). Разработанный способ прогнозирования общей выживаемости представляет собой многофакторную балльную оценку факторов прогноза. Выводы. Шкала индивидуального прогноза у больных с опухолями проксимальных желчных протоков, учитывающая как клинические, так и патогистологические характеристики опухоли, может быть полезна для оптимизации лечебной тактики, при принятии решения о проведении оперативного вмешательства и его объема, а также индивидуализировать показания к проведению адъювантной химиолучевой терапии.Введение. Разработан способ прогнозирования общей выживаемости у больных воротной холангиокарциномой, перенесших хирургическое вмешательство, в основу которого положены значимые клинико-патологические факторы опухоли. Материал и методы. В анализ включены 55 пациентов с воротной холангиокарциномой, проходивших лечение с 2011 по 2015 г. в Институте хирургии им. А.В.Вишневского. Хирургическое лечение после билиарной декомпрессии было проведено у 37 (67,3%) больных. В отдаленные сроки наблюдались 36 (97,3%) оперированных больных. Проанализирована зависимость общей продолжительности жизни от клинико-патологических факторов опухоли с помощью моно- и полифакторного анализа регрессионной модели пропорционального риска Кокса у всех оперированных больных. Результаты. Общая 1-3-, 5-летняя выживаемость составила 75,1, 60,5, 37,7, 35% соответственно. При монофакторном анализе значимыми прогностическими факторами являются периневральная (p=0,05) и сосудистая инвазия (р=0,049), R1 резекция (p=0,01), стадия заболевания III и выше (p=0,03), инвазия в SI печени (p=0,004), степень дифференцировки клеток опухоли (grade) 2 и выше (p=0,0006). При полифакторном анализе было выявлено, что низкую общую выживаемость обусловливали: периневральная (p = 0,05) и сосудистая инвазия (p=0,008), степень дифференцировки клеток опухоли (p=0,001), стадия заболевания (p=0,05), хирургический край резекции (р=0,0345). Разработанный способ прогнозирования общей выживаемости представляет собой многофакторную балльную оценку факторов прогноза. Выводы. Шкала индивидуального прогноза у больных с опухолями проксимальных желчных протоков, учитывающая как клинические, так и патогистологические характеристики опухоли, может быть полезна для оптимизации лечебной тактики, при принятии решения о проведении оперативного вмешательства и его объема, а также индивидуализировать показания к проведению адъювантной химиолучевой терапии.


Karmazanovsky G.G.,Moscow State University | Pletneva V.Yu.,Av Vishnevsky Institute Of Surgery | Kashtanova N.Yu.,Av Vishnevsky Institute Of Surgery
Russian Electronic Journal of Radiology | Year: 2017

Purpose. To determine the feasibility of meta-analysis about pancreatic tumors in Russian scientific literature. Materials and methods. We searched the scientific electronic library eLIBRARY.RU on query "diagnostic imaging of pancreatic neoplasms". Out of 2444 publications, 1202 were in open access. In total, 34 articles were selected with consequent analysis of sections "Materials and Methods" and "Results and Discussion". Results. Out of 34 analyzed articles, only 13 (38%) had sufficient sample size (more than 100 patients). Demographic characteristics were reflected as follows: gender was indicated in 22 (64.7%) articles, age - in 24 (70.5%) publications. The most frequent pancreatic lesions described were ductal adenocarcinoma and neuroendocrinal neoplasms (NEN) (11 articles - 29.7% each), followed by serous cystadenoma, intraductal papillary mucinous neoplasm (IPMN) (7 articles - 18.9% each), mucinous cystadenoma and SPPN/SPP-carcinomas (6 articles - 16.2% each). The most common methods for pancreatic tumor imaging were MSCT with intravenous contrast enhancement (88.0%) and transabdominal ultrasound (79.0%) with MRI (61.8%) and endoscopic ultrasound (56.0%) used less frequently. The most frequent diagnostic combination was transabdominal ultrasound and MSCT, in some cases supplemented with MRI. Conclusion. Data of Russian publications is comparable to the world literature. With the goal of meta-analysis in mind, it is advisable to increase the observation period (include larger number of patients), clearly define patient gender and their age in the "Materials and Methods" section (for subsequent comparison of data), use generally accepted statistical parameters and analyze causes of false-positive and false-negative results via pathomorphological studies.


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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