[Sipple syndrome (review of foreign literature)].
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Adrenal Gland Neoplasms↗
Biomedical subjects
P S Vetshev
Publications and source records attributed to P S Vetshev.
[Primary hyperparathyroidism].
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Diagnosis, Differential↗
[Thin-needle aspiration biopsy of solitary formations of the thyroid gland].
The paper analyzes the use of thin-needle aspiration biopsy in 372 patients with thyroid solitary formations. By the results of clinical and instrumental studies and cytological examination of thyroid puncture specimens groups of patients with individual clinical and morphological types of the disease were identified. Differential surgical policy in each group of patients was shown on the basis of the finding. It is concluded that thin-needle aspiration biopsy should be integrated into the compulsory programme of comprehensive examination of patients with thyroid solitary formations. Having a high efficiency, the above method helps in most cases to make an accurate clinical and morphological diagnosis and to choose the optimal treatment policy for each specific patient admitted to a surgical hospital for an aggregate diagnosis of nodal euthyroid goiter. Some patients may avoid unjustifiable surgical intervention and be on conservative therapy under follow-up.
Adult↗
[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↗
[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↗
[Thirty years of experience in the surgical treatment of patients with generalized myasthenia].
The article deals with 30-year experience of the Burdenko Facultative Surgical Clinic in surgical management of generalized myasthenia. The analysis is based on 2,500 cases. This complex disease was worked out in stages, taking into account the advancements of the medical science in the given stage. It is noted that the immediate and late-term results of surgery improved after introduction of the newest methods of examination and treatment of patients with myasthenia into practice. Among these methods are CT and MRT, immunohistochemical study, and treatment with steroids and immunodepressants. The role and significance of sorption methods and splenectomy in combined treatment of serious forms of myasthenia are pointed out. The elaboration of the clinico-immuno-morphometric criteria allowed the authors to prognosticate the results of surgical treatment with high authenticity and distinguish two types of myasthenia, as a result of which the indications for surgery could be determined more precisely. The authors direct the way to further research in this field for improvement of the diagnosis and the results of treatment of generalized myasthenia.
Combined Modality Therapy↗
[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↗
[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↗
[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↗
[Autoimmune thyroiditis: pathogenesis, morphogenesis and classification].
Autoimmune thyroiditis (AT) are a heterogenous group of organ specific autoimmune diseases (AID) of the thyroid. Their pathogenesis is associated with predisposing, initiating and promoting factors. Morphogenesis is based on the hypersensitivity reaction of the immediate and delayed types with the development of acute or chronic immune inflammation in combination with atrophic and hyperplastic alterations of the parenchyma (reaction of neutralization and inactivation). AT can be subdivided into primary ones (Hashimoto's thyroiditis, chronic lymphocytic thyroiditis, chronic atrophic thyroiditis) and the secondary ones which are the manifestation of the organ-specific AID.
Atrophy↗
[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↗
[Magnetic resonance tomography in the diagnosis of surgical diseases].
The authors analyse the first experience in the use of magnetic resonance tomography (MP-tomography) in the diagnosis of some surgical diseases. MR-tomography of the mammary gland (257 patients), thymus (55 patients), adrenals (41 patients), and hypophysis (18 patients) was conducted. The results of the examination were compared with the findings of other diagnostic methods and verified intraoperatively and histologically. The authors claim that the high informativeness of MR-tomography, its noninvasiveness, the absence of a radiation load, and the possibility of repeating the examination many times in three mutually-perpendicular planes distinguish the method favorably and dictate the necessity of its further study in clinical medicine.
Adrenal Gland Diseases↗
[Clinico-immunological features of generalized myasthenia in patients with hyperplasia and atrophy of the thymus gland].
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Adolescent↗
[Intraoperative ultrasonographic examination in surgery of the biliary tract].
The diagnostic value of intraoperative ultrasonic examination (IUSE) in surgery on the biliary tract was shown from analysis of the literature and the authors' experience. IUSE in more than 300 patients demonstrated a high resolving power in the diagnosis of choledocholithiasis and the absence of radiation load, allergic reactions and complications. In comparison of IUSE with intraoperative cholangiography in the diagnosis of stones in the gallbladder the total efficacy of the methods was 98.2% and 92.6%, respectively. IUSE has no side effects, is a simpler and cheaper method of examination, and allows goal-oriented removal of stones from the biliary tract. It is shown that with accumulation of experience in IUSE the performance of intraoperative cholangiography can be brought to the minimum.
Adult↗
[Diagnosis of lesions of the thymus gland in generalized myasthenia gravis].
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False Negative Reactions↗
[Clinical value of fine-needle aspiration biopsy of the thyroid gland].
The work compares the results of fine-needle aspiration biopsy (FAB) of the thyroid gland in nodular and diffuse-nodular euthyroid goiter (63 patients) with the findings of pathomorphological study of the operative material (51 patients). The authors' original device for puncture of the thyroid node is described. The suggested method makes it possible to raise the efficacy of obtaining an adequate amount of aspired material to 92%. On the basis of the results of FAB and ultrasonic examination (USE) unfounded surgical intervention was avoided in 12 of the 63 cases. The results of the study bear evidence of the high diagnostic efficacy of FAB as to obtaining the cytologic material and revealing malignant degeneration (96% specificity). The authors believe that FAB in combination with USE should be an obligatory component of complex clinico-instrumental examination of patients with various diseases of the thyroid, nodular forms of affection in particular.
Adolescent↗
[Diagnosis and surgical treatment of myasthenia gravis in childhood].
Thirty-year experience in surgical treatment of myasthenia in children and adolescents (175 patients) is generalized. It provides evidence of delayed recognition of this disease in many patients and of prolonged, often ineffective nonoperative treatment. Operation for thymectomy should be one of the main methods for the management of myasthenia in children. Operative treatment is indicated in a disease of moderate severity or in a severe course of myasthenia, particularly in patients with the first type of immunomorphological changes. It is important to amend the myasthenic disorders before the operation by means of maximally possible doses of anticholinesterases with addition of corticosteroids, whenever necessary. Whatever the method of treatment chosen, the patients must be kept under skilled dynamic control. Excellent and good late-term results were produced in 84.6% of cases.
Adolescent↗
[Cortical-cell thymomas with predominance of so-called nurse-cells in patients with myasthenia].
30 thymomas in patients with generalized myasthenia studied histologically and immunohistochemically are classified as cortico-cell thymomas (n-15), medullary-cell (n-1), mixed-cell (n-10) and cortical-cell thymomas consisting mainly of thymic "nurse"-cells. Pronounced histological features of thymomas with the predominance of "nurse"-cells allow one to consider them as a special variant of thymic tumours. Production of thymic hormones by tumour cells in combination with the loss of HLA-DR antigen expression may be of importance in the pathogenesis of autoimmunization in patients with myasthenia.
Cell Count↗