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N S Kuznetsov

Publications and source records attributed to N S Kuznetsov.

At least 19 recordsLinked to original sources
PubMed2001

[Long-term results of the surgical treatment of patients with multinodular euthyroid goiter].

Long-term results of treatment of 280 patients operated for multinodal euthyroid goiter (MNEG) in surgical department of Endocrinology Research Center RAMS from 1983 to 1997 were studied. Hormonal examination of peripheral blood, ultrasonic examination of thyroid gland (TG) and zones of regional lymph outflow, thin-needle punch biopsy were used as special methods of investigation. Correlation between recurrence and histological form was studied. In cystic-colloid goiter with adenomatosis the recurrence of MNEG was revealed in 15 (34.1%) cases. In primary multiple TG adenomas of different types the number of recurrences was smallest--1 (3.3%) cases. There were no recurrences in cancer of TG in combination with cystic-colloid goiter or adenomas of TG. Recurrence of cystic-colloid goiter was revealed in 5 (5.7%) cases, different types of adenomas--in 5 (5.7%) cases. The smallest number of recurrences of MNEG was seen after maximum subtotal resection of TG--in 4 patients (7.7% of the patients with this volume of operation). In all the 12 cases of partial resection of TG the recurrence of different morphological forms of MNEG was revealed. Influence of thyroid therapy on remote recurrence rate in different form of MNEG was also studied. In cystic-colloid goiter (CCG) of different proliferation degree with adenomatosis the recurrence rate was not significantly different irrespective of hormonal therapy--29.4%, 37.5% and 36.4%, respectively, in adequate therapy, inadequate therapy and its absence, that testifies to small influence of thyroid therapy on reduction of recurrence rate in this group of patients. The highest recurrence rate in CCG and CCG with adenomas of TG was revealed in the group without thyroid therapy--30.8% and 35.7%, respectively.

Adenocarcinoma↗
PubMed2000

[Treatment of malignant pancreatic islet cell tumors].

Among 142 patients with islet cell tumor who were admitted to hospital between 1982 and 1999, 15 patients (10.6%) had malignant tumours. The mean age was 45.3 +/- 5.8 years. Islet cell tumors were located in the head and corpus of the pancreas in 26.6% and 26.6% of the patients, respectively, in the tail of the pancreas in 46.8% of the patients. The mean size of the tumor was 2.9 +/- 0.7 cm, in 6 patients (40%) liver metastases were found. US, CT and angiography which sensitivity were 72.7, 100 and 85.7%, respectively, were used for topical diagnosis of the islet cell tumors. 12 patients were operated on (15 operations) and 3 patients were treated conservatively by streptozocin. Surgical procedures included distal pancreatic resection (n = 11), enucleation of the tumor (n = 2), hepatic resection (n = 1), abdominal exploration (n = 1). In 2 patients palliative pancreatic resections were combined with transarterial embolization and devascularisation of the liver metastases and 2 patients were treated by systemic chemotherapy. To reveal malignancy before and during the operation was possible only by evaluation of distant metastases and the adjacent organs infiltration. In other cases to determine the diagnosis was possible only after planned histological identification of the resected specimens. 5-year survival rates after conservative and surgical treatment were 33% and 62.5%, respectively. In patients without distant metastases 5-year survival rate was 100%.

Adult↗
PubMed2000

[Multiple endocrine neoplasia of the first type (Wermer's syndrome)].

11 patients with Wermer's syndrome (WS) aged 24-67 years were treated. They had a total of 30 tumors: 4(13.3%) hypophyseal, 11(36.7%) pancreatic, 9(30%) parathyroid, 4(13.3%) adrenal and 2(6.7%) duodenal. Each patient had two tumors minimum and 8 tumors maximum. In 8 cases WS presented clinically as hypoglycemia, in 3 cases as Zollinger-Ellison syndrome. The diagnosis was made using ultrasonography, CT, MRT and angiography. Cytogenetic examination was made in 2 cases. All the patients were operated. Six of them were operated two times, one--four times. The following surgery was made: 4 removals of parathyroid adenomas, 4 adrenalectomies, 1 removal of the hypophysis, 4 enucleations of pancreatic insulinomas, 5 distal hemipancreatectomies, 1 distal subtotal resection of the pancreas, 1 gastropancreatoduodenal resection. Clinically symptomatic tumors should be operated first.

Adult↗
PubMed1999

[Diagnosis and surgical treatment of organic hyperinsulinism].

From 1982 to 1998 144 patients (males 31.7%, females 68.3%) with organic hyperinsulinism underwent surgery. Mean age of the patients was 44.2 +/- 4.6 years. The causes of the development of this disease were benign insulinoma (82.6%), malignant insulinoma (6.9%), beta-cells hyperplasia and microadenomatosis (4.2%). In 6.3% of the patients the origin of the disease was not established. The location of the insulinoma in the pancreatic head was detected in 33.8%, in the body--in 35.2%, in the tail--31%. The sensitivity of the used methods of topical diagnosis was the following: US--40.3%, CT--28.6%, angiography (selective celiacography and upper mesentericography)--76.9%, blood samples from the right hepatic vein after intraarterial stimulation of different parts of the pancreas by Ca with measurement of immunoreactive insulin level--87.2%, intraoperative palpation--86.5%, intraoperative US examination--100%. Preoperatively, the authors used combined angiographic examination, the sensitivity of which made up 94.9%, this study being a single one which allows to reveal the region of the lesion of the pancreas in beta-cells hyperplasy. Tumor enucleation (59 patients), distal resection of the pancreas (50), the excision of the insulinoma (25), duodenopancreatic resection (1), explorative laparotomy (9) were made. Postoperative complications rate arose in 43.6% of the patients, mortality rate--7.7%. The best results were achieved in enucleation of insulinoma and distal resection of the pancreas. The authors suggest that in preoperative diagnosis of insulinomas the preferable methods should be US-examination and combined angiographic examination. Intraoperative revision should be made with use of US examination. Depending on the intraoperative findings the preference should be given either to enucleation of insulinoma or to distal resection of the pancreas.

Adolescent↗
PubMed1998

[Diagnosis and treatment of breast cysts].

The results of examination and treatment of 62 patients with breast cysts are presented. Basing on ultrasound and cytological examination evidence, indications and contraindications for puncture treatment of breast cysts with simultaneous 96% ethanol sclerosing with have been worked out. This treatment was carried out in 45 patients, the rate of recurrences being 11.1% compared to 21.9% in the control group. The puncture treatment is indicated in the mass of regular shape of homogenous unechogenous structure with symmetric "lateral shades" revealed by US examination, absence of atypical intracystic epithelium according to cytologic examination data. Contraindications for this method are the following: presence of intracystic growth, irregular shape of the cyst, asymmetric "lateral shades", polycystic disease of the breasts, cellular atypia revealed by cytologic examination, recurrent cyst, previuns mastectomy for breast cancer, atypical ductal or lobular hyperplasia revealed in sectoral resection.

Adult↗
PubMed1997

[Potentialities of ultrasound examination in differential diagnosis of benign nodules and breast cancer].

The results of examination of 410 patients with nodular masses of the breast are analysed. Benign tumors were present in 314 (76.6%) of the patients, cancer of the mammary gland--in 96 (23.4%) of the patients. The tumors were classified into 3 types, depending on the intensity of the ultrasound wave behind the tumor. Based on the clinical and morphological analyses it was demonstrated that the presence of the acoustic wave behind the tumor is typical for the invasive cancer of the duct, scirrous carcinoma and lobular cancer. In medullar and mucosous cancer the intensity of the ultrasound wave does not change. In case of intracystic cancer the symptom of "back magnification" is present. The sensitivity of the ultrasound in detection of mammary gland cancer is 88.5%, specificity--96.5%. The analogous parameters of mammography are: 91.0% and 97.8%. In the use of ultrasound control in fine needle aspiration biopsy (FNAB) the sensitivity and specificity of the method increases from 88.5% to 92.7%. If the diagnosis of mammary gland cancer was established with the use of ultrasound and FNAB the additional use of mammography is not obligatory.

Adenocarcinoma, Scirrhous↗
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↗
PubMed1996

[Diagnosis, surgical treatment and prognosis in endocrine hypertension of adrenal origin].

162 patients with adrenal hypertension have been examined. 48 of them had Cushing's syndrome, 10--aldosteromas, 85 --icenko--Cushing disease. The examination of patients with endocrine hypertension included hormonal background study, computer and MR tomography thin-needle biopsy and made it possible to make valid clinical and topical diagnosis in all cases. Magnetic-resonance tomography appeared to be the most efficient diagnostic method in the syndrome of hypercorticoidism. Ultrasound examination is the most available and highly informative method of revealing hormonally active adrenal tumors when they are more than 1 cm in size. An adequate preoperative preparation equally with an optimal scope of surgery and efficient postoperative substitution hormonal therapy are key factors in treatment of endocrine adrenal hypertension.

17-Hydroxycorticosteroids↗
PubMed1995

[Informative value of various diagnostic methods in Itsenko-Cushing syndrome].

The authors discuss the comparative evaluation of different methods of examination applied in 36 patients with the Icenko-Cushing syndrome. The results of the investigation are compared with the intraoperative findings and the data of morphological studies. MR-topography proved to be mist informative. Ultrasonic examination was highly effective in tumors measuring up to 1 cm in diameter. The use of USE during the operation hor locatind the tumor and determining its connection with the surrounding organs allows the operation to be performed in a shorter time and its traumatic character.

Adrenal Gland Neoplasms↗
PubMed1995

[Ultrasound diagnosis of breast nodules].

The authors show the comparative data on ultrasonic examination and mammography in 204 patients with nodular new growths in the breast: 66 had breast carcinoma and 138 had benign diseases. They suggest 6 ultrasonic criteria characteristic of breast carcinoma and describe the ultrasonic picture of the most commonly encountered benign breast tumors: fibroadenoma, nodular mastopathy, cysts. USE sensitivity was 68.8 +/- 7% in breast carcinoma, 82.6 +/- 8.1% in fibroadenoma, 72.8 +/- 7.2% in nodular mastopathy, and 100% in cysts (the respective values in mammography were 76.7 +/- 6.4%, 69.6 +/- 9.8%, 74.4 +/- 7%, and 60 +/- 11.2%). USE sensitivity and sensitivity of mammography were found to differ for different age categories in early forms of breast carcinoma. It is shown that the histological structure of a malignant tumor may be assumed from the ultrasonic criteria. The authors conclude that USE has a high diagnostic value in nodular new growths of the breast and that differential diagnosis of malignant and benign lesions is possible.

Adult↗
PubMed1994

[The informative value of various diagnostic methods in Itsenko-Cushing's disease].

The authors studied the informative value of various diagnostic methods: ultrasonic examination (USE), computed tomography (CT), magneto-resonance tomography (MRT), phlebography with separate collection of blood from the inferior vena cava and its hormonal investigation in Itsenko-Cushing's disease (52 cases). All patient underwent operation, and because of this the changes detected in the adrenals by various diagnostic methods of examination were compared with the morphological findings. Three patients were subjected to bilateral adrenalectomy. Morphological study of the adrenals revealed diffuse hyperplasia of the cortex in 17 cases, macro- and microadenomas in hyperplasia of the adrenals in 23, and diffuse-nodular hyperplasia in 15 cases. In macroadenomatosis identification, the informative value of MRT was 77.8%, CT 66.6%, and USE 22.2%. MRT was most informative in detection of microedenomatosis and diffuse-nodular hyperplasia--82.3% of cases; the respective values for CT and USE were 71.4% and 56.5%. The quantitative parameters of the adrenal tissue were studied in MRT: relaxation time (T-2) and the value of relative signal intensity (E). The value of relative signal intensity was lower in micro-macroadenomatosis than in diffuse and diffuse-nodular hyperplasia. The use of the quantitative parameters (T-2 and E) increases the diagnostic possibilities of MRT and provides for a more authentic idea of the character of the pathological changes in the adrenal tissue. Precise verification of the pathological process in the adrenal cortex allows the optimal treatment to be chosen, adrenalectomy to be considered in time, and the side of the operation to be correctly determined.

Adrenal Glands↗
PubMed1993

[Diagnosis, surgical treatment and prognosis in patients with generalized myasthenia].

The work deals with the clinical analysis of the richest experience in the surgical treatment of patients with generalized myasthenia in the country. The efficacy of various methods for the diagnosis of affection of the thymus is studied comparatively. It is shown that for more effective diagnosis of neoplastic lesions of the thymus wider use of computerized and magneto-resonance tomography is expedient and that they must replace the insufficiently informative and invasive examination methods used today (pneumonodiastinography, phlebography, scintigraphy, etc.) which still form the basis for the system of diagnostic research in patients with myasthenia. The authors determined the indications and contraindications for, the optimum terms for undertaking the surgical intervention and its volume in neoplastic and nonneoplastic diseases of the thymus in adults and children. Comparative evaluation of various means of preoperative management was conducted. It is shown that to improve the patient's condition and stabilize the myasthenic status on the possibly minimal doses of anticholesteremic agents glucocorticoid hormones should be included in the complex of preoperative management. The indications for hormonotherapy were determined. The efficacy of plasmapheresis, radiotherapy, and glomectomy with denervation of the sinocarotid zone was evaluated and their place in the complex treatment of patients was determined. From study of the late-term results of treatment of a large group of patients (children, adults with a thymus) the main causes of unsuccessful surgical treatment of generalized myasthenia were identified and the concrete means of improving the results of treatment were planned. Two types of changes in the clinico-immuno-morphological values were revealed in patients with generalized myasthenia, differing evidently in pathogenesis. New clinico-immuno-morphological correlations and prognostic factors were discovered, and a method for prognosticating the effect of thymectomy was suggested. It is shown that splenectomy has a favorable effect in the most severe category of patients in unsuccessful operative and nonoperative treatment. The tactics of management of patients accepted in the clinic led to a uncomplicated course of the postoperative period in the majority of patients in the last years.

Adult↗
PubMed1993

[Comparative evaluation of diagnostic methods in thymus disease].

From analysis of the case records of 2,000 patients with the generalized form of myasthenia, who underwent operation at the surgical faculty clinic of the Moscow Medical Academy, the authors discuss in detail the results of using a wide spectrum of methods for examination of the thymus, including: pneumomediastinography (PMG), scintigraphy, phlebography, computed and magnetoresonance tomography (CT and MRT). Taking into account the sensitivity and specificity of each of these methods, the indications and contraindications, and the degree of invasiveness, the authors concluded that MR tomography is the method of choice for examination of the thymus. It yields the rechest information and is most simple and safe for the patient. They also noted that CT made it possible to locate the pathological process more exactly, and provided additional information on the degree of the invasion, the presence of implants, and the condition of the other mediastinal organs. The indications for phlebography of the thymus and PMG are limited because of their invasiveness, difficult techniques, high risk of complications, and relatively low informativeness. Scintigraphy of the thymus is the least informative examination method. In view of the high percentage of pseudopositive and pseudonegative results, it may be concluded that its use for detecting lesions of the thymus in patients with myasthenia is hardly expedient.

Humans↗
PubMed1993

[Intraoperative ultrasonography in Itsenko-Cushing's disease and syndrome].

Ultrasonic study conducted during an operation is finding wider use lately. Surgery is the main method of treatment of most diseases of the adrenals, therefore problems of topical intraoperative diagnosis are very urgent. Twenty-three patients were operated on for Itsenko-Cushing's disease and syndrome and tumors of the retroperitoneal space at the Faculty Surgical Clinic of the Moscow Medical Academy within a period of 12 months. All patients were subjected to complex ultrasonic examination, including pre-intra- and postoperative study. Intraoperative ultrasonic study was conducted in two stages: stage 1--examination after thoracotomy through the diaphragm for choosing the optimal place and length of phrenotomy; stage 2--ultrasonic examination after phrenotomy to localize precisely the adrenal or tumor and reveal their connection with the adjacent organs and vascular structures. Complex ultrasonic examination has advantages over the other examination methods (computed tomography, angiography, scintigraphy) which allows it to come to the forefront in the diagnostic search for adrenal tumors. Intraoperative ultrasonic examination makes it possible for the surgeon to avoid wide phrenotomy and prolonged investigation, reduces the possibility of inflicting injury to the large vessels, which reduces the duration of the operation and anesthesia, and improves the course of the postoperative period.

Adult↗