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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.

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.

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.

The authors carried out comparative assessment of sensitivity and specificity of ultrasonic examination with color dopper mapping (USE with CDM), thin-needle aspiration biopsy--TAB (palpation- and US-assisted), express histologic examination--(EHE), intraoperative laser autofluorescent spectroscopy (IOLAS) with retrospective assessment by results of elective histologic examination in adenomas of thyroid gland (TG). Medical histories of 135 patients hospitalized with adenomas of TG of follicular cells were analyzed. Based on comparison of USE with CDM and morphologic analysis of TG adenomas three types of specific echographic symptomcomplexes were recognized. USE with CDM in combination with US-assisted TAB was the most effective diagnostic complex before operation. Comparative analysis of results of these methods with express histologic examination showed equal efficacy, that permitted to reject routene EHE. For the first time IOLAS was used as "optic instant-biopsy" for selection of optimum scope of surgery when "follicular neoplasia" was suspected. Combined use of USE with CDM and TAB before operation as well as IOLAS enabled correct diagnosis of the nature of TG lesion, it morphologic type, and based on these data adegnatechoice.