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L I Ippolitov

Publications and source records attributed to L I Ippolitov.

At least 19 recordsLinked to original sources
PubMed2005

[Disputable points and negative tendencies in diagnosis and surgical treatment of accidentally revealed adrenal tumors].

Two main problems are discussed in detail: differential diagnosis of adrenal tumors before surgery, and policy of treatment of these patients. Indications for fine needle biopsy are determined, based on personal and world experience reasoned indications to surgical treatment and follow-up are formulated. Some negative tendencies in adrenal surgery are also discussed.

Adrenal Gland Neoplasms↗
PubMed2005

[Disputable problems in diagnosis and treatment of catecholamine-secreting tumors].

The article covers the main problems and disputable points in diagnosis and treatment of pheochromocytoma: differential diagnosis before surgery and treatment which policy. The authors define a specific group of patients required a comprehensive deep examination (group of risk) for chromaffin tissue. Differentiated use of different methods of diagnosis of catecholamine-secreting tumors is validated. Some last est negative tendencies in adrenal surgery are also discussed.

Adrenal Gland Neoplasms↗
PubMed2004

[Forty-year experience of surgical treatment of generalized myasthenia].

Forty-year experience with surgical treatment of generalized myasthenia (GM) based on 2977 cases is analyzed. Role of special methods of mediastinum examination (CT, MRT) is demonstrated, indications to thymectomy are validated. It is noted that developed diagnostic algorithm, surgical technique, management before and after surgery improved significantly immediate and long-term results. Development of clinical, immunological and morphologic criteria of thymectomy effect permitted to predict course of GM and to optimize complex therapy after surgical treatment.

History, 20th Century↗
PubMed2003

[False acute abdomen in clinical practice].

Some situations in which endocrinological diseases and their complications (diabetic ketoacidosis, acute adrenal failure, pheochromocytoma, thyrotoxicosis, thyrotoxic crisis, hyperparathyroidism crisis) give the picture of false acute abdomen are analyzed.

Abdomen, Acute↗
PubMed2003

[Current aspects of diagnosis and treatment of symptomatic arterial hypertension of adrenal genesis].

AIM: To analyse the experience in diagnosis and treatment of arterial hypertension (AH) of adrenal genesis. MATERIAL AND METHODS: A total of 243 patients with adrenal AH (mean age 46.3 +/- 3.2 years) were examined. 134 of them had endogenic adrenohypercorticism (EAH), 62--primary hyperaldosteronism (PHA), 47--chromaffin tissue tumors (CTT). Diurnal urinary excretion of adrenal hormones (epinephrine, norepinephrine, aldosteron, hydrocortisone) and peripheral blood hormones (aldosteron, renin, hydrocortisone, ACTH) were measured. Topic diagnosis was made with ultrasound, computed tomography, MR-imaging, angiography, adrenal venous sampling and 123I-MIBG scintigraphy. RESULTS: Adrenalectomy was made in 224 patients (predominantly with tumor lesions). 19 patients (idiopathic hyperaldosteronism, advanced adrenocortical carcinoma) were treated conservatively (calcium antagonists, ACE inhibitors, AT1-receptor blockers, spironolacton). Good results of the surgical treatment were achieved in 60% patients with aldosterone-producing adenoma and adrenal Cushing's syndrome as well as in 80.5% patients with pheochromocytoma. Long-term outcomes depend on hypertension duration, histologic type of the tumor, age and family hypertension history (risk of essential hypertension). CONCLUSION: Hypertension of adrenal origin occurs more frequently than it was supposed previously. Its late diagnosis may be due to lack of typical signs and symptoms, insufficient application of novel diagnostic techniques and poor alertness of physicians. It is recommended to include tests for adrenal hormones in urine and blood and ultrasound investigation of the adrenals in a complex of primary examination of patients with severe refractory hypertension.

Adrenal Cortex↗
PubMed2003

[Surgical treatment of thymomas in patients with generalized myasthenia gravis].

Experience in surgical treatment of 2977 patients with generalized myasthenia is presented, 386 (13%) of them have undergone surgeries for thymus tumors. Organo-specific tumors (thymoma) were diagnosed in 370 (95.9%) of them. Computed and magnetic-resonance tomography has the highest sensitivity and specificity in diagnosis of thymus tumors. Thymomthymectomy was performed in 317 patients including extended one in 117 (36.9%). Postoperative lethality in thymic tumor in the last years was 0.5%, general lethality over all period--5.1%. According to used classification (WHO, 1999) types of thymoma were the following: type A--2.1%, type B--86.3%, type AB--9.6%. Prognosis of surgical treatment depends of tumor type (it is worse in type B than in types A and AB), duration of the disease and severity of myasthenia.

Adolescent↗
PubMed2002

[Surgical stress in different cholecystectomies].

For determination of surgical stress degree and evaluation of long-term results prospective randomized study was carried out. Three representative groups were compared: patients undergone traditional cholecystectomy (TCE)--95 patients (1 group), laparoscopic cholecystectomy--91 patients (2 group), minimally invasive cholecystectomy--92 patients (3 group). Level of stress hormones (before, during and after surgery), parameters of external respiration (before and after surgery), doses of analgetics (or their combinations) which were necessary for adequate analgesia in early postoperative period depending on surgical method were used as objective criteria of surgical stress. Based on evaluation of patients quality life reliable difference in first three years after surgery between patients undergone TCE and ones undergone minimally-invasive surgery was demonstrated.

Adult↗
PubMed2002

[Diagnosis and surgical treatment of primary hyperaldosteronism].

Primary hyperaldosteroneism (PHA) is one of the main causes of secondary arterial hypertension (AH). Medical histories of 62 patients with PHA were analyzed. aldosterone-produced adenoma (APA) was diagnosed in 37 (59.7%) patients (all of them were operated), idiopathic hyperaldosteroneism (IHA)--in 25 (40.3%) patients, 11 of them were operated. Complex clinical and instrumental examination (hormonal analysis, USI, CT, MRT, in difficult cases in 35 patients--selective phlebography with blood sampling) was carried out in all the patients. Clinical picture in the majority patients with PHA was unclear. Hypokaliemia is not obligatory symptom of PHA. AH is often the only symptom of PHA, therefore all the patients with AH require complex laboratory examination including repeated detection of potassium blood level, examination of serum aldosterone concentration and renin activity, diurnal urinary excretion of aldosterone. In difficult differential diagnosis between APA and IHA it is necessary to perform selective phlebography with blood sampling from inferior cava and adrenal veins with obligatory detection of aldosterone and hydrocortisone concentration. Diagnostic and curative algorithm are developed. Surgical treatment is indicated for patients with APA, and also for ones with IHA who had functionally dominant adrenal gland (based on selective blood sampling analysis) and resistant for drug therapy AH.

Adrenal Glands↗
PubMed2002

[Tumors of chromaffin tissue (symptoms, diagnosis, surgical treatment)].

Medical histories of 167 patients with tumors of chromaffin tissue were analyzed. Pheochromocytoma was diagnosed in 124 (74.2%) patients, pheochromoblastoma--in 32 (19.2%), extraadrenal tumor--in 11 (6.6%): paravertebral (4), between aorta and vena cava inferior (2), behind the tail of the pancreas (1), at lower pole of the kidney (2), in Zukerkandl's organ (1), in the urinary bladder (1). Complex examination (hormonal profile, US, CT, MRT) was carried out in all the patients, in difficult cases in 71 (42.5%) patients angiography was performed, and in 7 (4.2%)--scintigraphy. The device examination provided accurate diagnosis in all the cases. In the majority of patients (72) clinical picture of the disease was characterized by a typical crisis course. There were no clinical symptoms in patients with "silent" pheochromocytoma, tumor was revealed occasionally in all the cases. One hundred and sixty-four patients were operated. Total lethality was 3.6%. Long-term results were analyzed in 137 patients. Radical removal of pheochromocytoma led to stable normalization of arterial pressure in 73.2% patients. Non-invasive methods (polyposition US with colored doppler, CT, MRT) are methods of choice for topic diagnosis of pheochromocytoma. Sensitivity of US with colored doppler reached 94.3%.

Adolescent↗
PubMed2001

[Diagnosis and surgical treatment of arterial hypertension of adrenal origin].

230 patients with arterial hypertension of adrenal origin were treated. 205 of them underwent adrenalectomy with surrounding paranephral fat. There were no lethal outcomes. Endogenic adrenocorticism was diagnosed in 134 patients. Cushing's syndrom was in 96 patients, Cushing's disease--in 34, ACTH-ectopic syndrome--in 2, adrenocortical cancer--in 2. Primary hyperaldosteronism was diagnosed in 42 cases: idiopathic hyperaldosteronism in 23 patients, aldosteronproducing adenoma (Conn's syndrome)--in 19. Tumors of chromaffine tissue were defected in 30 patients. All the patients underwent complex examination (hormonal profile, US, CT, MRT, angiography if it was necessary). Symptomatic arterial hypertension of adrenal origin was diagnosed during one year in 10% patients only because of absence of typical clinical picture. Use of complex examination has permitted to make a correct topical diagnosis and to choose optimum treatment policy in all the cases.

ACTH Syndrome, Ectopic↗
PubMed2001

[Cholecystectomy by mini-approach in the treatment of cholelithiasis].

Along with wide-spread laparoscopic cholecystectomy, cholelithiasis can be treated with another sparing technique--miniaccess cholecystectomy (MACE). Case histories and long-term treatment outcomes were analysed for 168 patients aged 23-77 years subjected to MACE with elements of open laparoscopy for chronic calculous cholecystitis. Surgery was made using a special surgical kit "Mini-assistant" by the team of two surgeons and an instrument nurse. After MACE the patients resume their jobs after a shorter period of inability, suffer from side effects of surgery in rare cases, have higher quality of life than patients after laparoscopic cholecystectomy.

Cholecystectomy↗
PubMed2001

[Resources of intraoperative diagnosis of thyroid gland diseases].

The method of intraoperative laser autofluorescent spectroscopy (IOLAS) has been developed and introduced in clinical practice for improvement of intraoperative diagnosis of thyroid gland diseases. 112 patients (17 men, 95 women, mean age 46.5 +/- 3.8) with various thyroid diseases were examined. Benign diseases were revealed in 96 (85.7%) patients, thyroid cancer--in 16 (14.3%). All the patients were operated. Rapid histologic examination and IOLAS were performed in all the patients. Main spectral characteristics and criteria of differential diagnosis of benign and malignant thyroid diseases were determined. High diagnostic value of this method was demonstrated. Results of IOLAS were compared with USI, thin-needle aspiration biopsy, express histologic examination. Sensitivity of IOLAS in differential diagnosis of malignant thyroid diseases achieves 95.4%, specificity--97.6%. IOLAS permits to clarify the morphology of thyroid lesions and to choice optimal scope of surgery. In accordance to IOLAS the scope of planned surgery was expanded in 18.2% cases that permitted to avoid repeated operations after elective histologic examination. It is concluded that the method may be used for optimisation of intraoperative diagnosis of thyroid diseases.

Adult↗
PubMed1999

[Adrenal tumors found by chance. Surgical treatment or follow-up?].

206 case records of the patients treated from 1985 to 1998 for various diseases of the adrenal glands were analyzed. In 39 (18.9%) patients tumors were chance finding at ultrasound examination or computer tomography of the abdominal cavity and retroabdominal space. 25 patients from this group were operated on, 14 patients were not operated and were followed up from 1 month to 7 years. All the patients underwent complex examination including analysis of the complaints, anamnesis and physical examination data, hormonal status examination (ACTH, hydrocortisone, 11-oxycorticosteroids, 17-ketosteroids, aldosterone, renin, adrenalin, noradrenalin, vanillyl-mandelic acid), device methods of examination USE, CT, MRT, superselective phlebography with separate catheterization of adrenal veins and blood intake per floor, fine needle aspiration biopsy under ultrasound control. Comparison of the results of complex clinical examination with morphological data of removed adrenal glands was carried out retrospectively. Arteriography and superselective phlebography with separate catheterization of adrenal veins and per floor taking of blood samples, performed in 36 patients, enabled not only to supplement and define more exactly the other methods of topical diagnosis, but also to asses objectively functional actively of the affected and contralateral adrenal. Despite the fact that during the study of hormonal level in peripheral blood of patients it was normal analysis of the data obtained by superselective phlebography of adrenal veins and per floor taking of blood samples showed significant increase in hormones level in blood of all operated patients. Comparison of the data of superselective phlebography with separate catheterization of adrenal veins and per floor taking of blood samples and clinical picture of the disease made it possible to suggest the presence of preclinical (subclinical) Cushing or Conn syndrome. Operative treatment was not indicated in the absence of hormonal activity of the tumor (i.e. preclinical syndromes by Icenko-Cushing, Conn, pheochromocytoma, the virilizing and feminizing tumors), tumors of small size (less than 3 cm), in absence of malignant growth features confirmed by complex instrumental examination (USE, CT, MRT, fine-needle aspiration biopsy under US control, superselective phlebography with per floor taking of blood samples). Such patients were reexamined in 6 months. During the follow up period no changes of tumor size, homogeneity, hormonal status were revealed.

Adrenal Cortex Hormones↗
PubMed1998

[Cholecystectomy from mini-approach with the elements of open laparoscopic technique in surgical treatment of cholelithiasis].

The experience and the technique of cholecystectomy from mini-approach with elements of open laparascopic technique (MSE) in 102 patients with choledocholithiasis and calculous cholecystitis is descubed. In 99 cases the operation was carried out for chronic calculous cholecystitis, in 3 cases--for acute calculous cholecystitis. The patients were aged from 23 to 76 years (mean age 59.3 +/- 3.4 years). The average length of the incision in performing MSE made up 4.1 +/- 0.3 cm. Mean duration of the operation 42.4 +/- 5.3 min. In 5 cases (4.9%) intraoperative cholangiography was performed. The possibility to avoid the use of narcotic analgetics in postoperative period in patients who underwent MSE is demonstrated. Postoperative period made up 3.8 days. Social and cost-effect aspects of different modes of surgical treatment of patients with cholelithiasis are considered. The study of quality of life index makes it possible to come to conclusion about quicker return of the patients who underwent MSE to their habitual social and intellectual activities, practically complete absence of the influence of negative factors of conventional treatment (pains, dyspepsial, cosmetic defects) higher appreciation of their health conditions, well being, which manifests in higher quality of life in operated patients.

Adult↗
PubMed1997

[Clinical and morphological analysis of adrenal cortex adenomas].

Case 31 patients with Cushing syndrome are analysed. On the basis of the number of the atypical cells from dark-cell adrenal cortex adenomas, giant-cell adenomas were differentiated as a separate morphological type. Blood concentration of hydrocortisone depends on the cell composition of adenomas. Clear-cell adenomas can be hormone-active and hormont-inactive. The quantitative parameters oblained NMR-tomography, allow detecting morphological type of the tumor with greaf accuracy.

Adolescent↗