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Primary hyperparathyroidism is the most common disease in Russian Federation, cured by endocrine surgeons. Health status after surgical correction of primary hyperparathyroidism depends on availability of screening hypercalciemia, which is still absent in our country. Another problem is a model of surgical management of primary hyperparathyroidism (frozen section, intraoperative monitoring of parathyroid hormone, gamma-detection and so on). Although minimally invasive parathyroidectomy has become the only method of treatment in many countries, it is still crucial to identify and accurately localize parathyroid glands before bilateral neck exploration surgery. The diagnostic efficacy of the various imaging techniques is still the subject of current debate. The usefulness of preoperative parathyroid imaging with both dual scintigraphy-single-photon emission computed tomography (SPECT) Tc 99m and high-resolution ultrasonography (US) was studied in 92 patients undergoing operations for primary hyperparathyroidism. The accuracy of "integrated" ultrasonography ("check-up US", "target US" after SPECT) and "intraoperative US") of parathyroid glands was 92.9%, sensitivity - 91% and positive predictive value - 94%. This study supports an algorithm of obtaining "integrated" ultrasonography as the initial and in most cases the only preoperative localization tests for patients with primary hyperparathyroidism.

The article summarizes the experience of surgical treatment of 47 patients (1964-2012 yy) with lung arteriovenous malformations (LAVM). Men were 29, women - 18. Age varied from 6 to 49 years. 20 patients had solitary lung arteriovenous malformations, the rest 27 had multiple malformations. Before 1983 the main diagnostic means was the angiopulmonography, since that the multyspiral computed tomography has been used. Before 1980 all patients received major surgical treatment, i.e., lobectomy (n=29), pneumonectomy (n=1) and 1 explorative thoracotomy. After 1980 the endovascular embolisation under the X-ray control took the leading place among the treatment options for these patients. 11 patients had 17 embolisations; the lung resection was performed only in 3 cases. All negative outcomes (4 lethal and 8 complications) were registered before the 1980. The were no lethal outcomes after the endovascular embolisation; only 3 patients had complications. All patients demonstrated satisfactory and good outcomes, considering objective parameters and quality of life early and long after the endovascular embolisation.

Based on the performed studies, the authors developed test systems to analyze the expression of mRNA of the p53, C-myc, mad1, max, and E2F1 genes. These test systems could reveal a statistically significant difference between follicular adenoma and carcinoma of the thyroid in their expression of p53 mRNA. It should be noted that the use of our developed test systems is promising when searching for the diagnostic and prognostic markers of cancer, analyzing, and creating the genetic networks characterizing this or that cancer.

Treatment results of 300 patients with myasthenia gravis (MG) were analyzed. 150 patients with MG and thymoma formed the main group, the rest 150 patients with non-thymomatous MG comprised the group of control. Thymomatous myasthenia was more severe and resistant to therapy. 79 (48.7%) patients had thymoma type B, mixed thymoma type AB was found in 45 (30.0%) patients, the rest had medullary tumors type A. I stage of the tumor progression was registered in 62.0% of cases, stage III was the second to find among them (20.0%). Long-term follow-up revealed stable and statistically proved improvement of MG clinic in patients of the main group (p=0.013). Survival rate of patients with thymoma and MG were 91.2, 83.4 and 72.3% after 3-, 5- and 10 years, correspondingly. Survival rates for non-thymomatous MG were significantly higher: 96.0, 91.6 and 87.2% after 3-,5- and 10 years, correspondingly. Tumor characteristics showed no influence on MG course after the operation. As well, as for the patients of the control group, only severity of the disease was the significant factor for the MG prognosis. Oncological prognosis was defined by pathomorphological type of thymoma and its progression stage. Thymomthymectomy allowed not only tumor remission but also myasthenia course stabilization and improvement.

Demonstrated, that puncture thyroid hystobiopsy is safe and informative method of preoperative thyroid nodes diagnostics. Telomerase activity in tissue samples was significantly higher in case of malignant thyroid disease, although a positive correlation of telomerase activity was also with the amount of lymphocytes in bioptates. Combination of thyroid hystobiopsy with tissue telomerase activity measurement proved to be an effective means of preoperative diagnostic of patients with nodular goiter.

Results of diagnosis and treatment of 150 patients with thymoma and generalized myasthenia are analyzed. The results of examination were registered before surgery, and also in 1, 3, 5 and 10 years after one. It is demonstrated that thymoma is potentially malignant tumor with risk of recurrence and requires long follow-up of patient after operation. Morphologic type and stage of tumor, severity of myasthenia are the main predictors in the prognosis of surgical treatment. Thymomectomy with excision of fatty tissue of anterior mediastinum is absolutely indicated for this severe category of patients, and it decreases the risk of tumor progression. Mortality of patients depends not only on tumor growth or recurrence but also on concomitant myasthenic disorders.

Serum specimens from 52 myasthenic patients with thymoma of various histological characteristics and 4 patients with thymoma without myasthenia have tested for anti-Titin-antibodies titer. It has been demonstrated that organ-specific thymoma dominated at myasthenic patients, and organ-nonspecific thymoma - at the patients without myasthenia. There was no correlation between severe clinical symptoms and the level of anti-Titin-antibodies. The titer of antibodies at the patients with organ-specific thymoma was higher that at ones with organ-nonspecific thymoma, but there was no correlation between the level of anti-Titin-antibodies and histological type of organ-specific thymoma.

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.

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.

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.

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.

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.

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%.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.