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Possibilities of application of magnet-resonance tomography (MRT) for differential diagnosis of the adrenal glands tumors were studied up. MRT was conducted to 39 patients with adrenal glands tumors, including 22 - with malignant adrenal gland tumor, 17 - with benign tumor of adrenal gland. MRT constitutes the most effective method of topic diagnosis of the adrenal glands tumor, owes multipurpose possibilities, do not deliver radiation load, permits to visualize the vessels without the contrast media usage. The tumor diameter more than 10,1 cm, irregular form, illegible edges, uneven contours, presence of lymphadenopathy, regional or remote metastases constitutes diagnostic criterions of the adrenal glands malignant tumors. The intensity of MRT signal could not be used for differential diagnosis of malignant and benign tumors of adrenal glands.

Possibilities of ultrasound investigation (USI) application for differential diagnosis of the suprarenal glands tumors (SGT) were studied. USI was conducted in 169 patients with SGT, including 95 with malignant tumors of suprarenal glands (MTSG) and 64--with benign SGT. USI constitutes the main method of screening, permitting to reveal SGT in 90.5% of patients. Diagnostic criterions of MTSG were: diameter of tumor exceeding 10.1 cm, incorrect form, irregular edges, presence of invasion, lymphadenopathy, regional and remote metastases. In 45.3% of observations it was possible to establish the MTSG diagnosis, using USI.

Possibilities of computer tomography (CT) application for differential diagnosis of tumors of the adrenal cortex (TAC) were studied. CT was conducted in 157 patients with TAC, including 75--with malignant (MTAC), 82--with benign (BTAC), permitting to revealed MTAC in 76% patients. In 17.1% patients with BTAC false-positive results were noted, reducing, thus, the method diagnostic value. While the trustworthy signs of malignancy are absent, it is necessary to conduct morphological verification of the adrenal tumors nature using puncture biopsy and/or intraoperative express-cytological investigation.

Possibilities of application of the fine-needle aspiration puncture biopsy (FNAPB) in diagnosis of suprarenal glands tumors were studied. Of 43 patients, to whom FNAPB was performed, in 27 the suprarenal gland tumor was diagnosed, in 11--renal tumor, in 5--the puncture biopsy material occurred noninformative. Of 27 patients with tumor of suprarenal gland in 15 it was malignant, in 11--benign adenoma and cyst of suprarenal gland were revealed. FNAPB of the suprarenal gland tumor is a safe, informative and in some situations curative method. FNAPB is recommended for diagnosis of primarily revealed tumors of suprarenal glands more than 2 cm in diameter. The procedure should be performed by specially trained physician, who determines technical conditions of its conduction by himself and possesses the method o fultrasonography. Data of cytological investigationspermits to differentiate benign and malignant tumor, to determine the tumor type, what constitutes diagnostic background for the tactic choice of surgical intervention and the disease prognosis.

The extent of diagnostic possibilities of medical technique, permitting to reveal the majority of suprarenal tumors, and the most modem information technologies as well demands creation of the suprarenal tumors applicable classification, well-adopted for physician in practice and also for scientist dealing with analysis of the investigation results in these pathology. Taking into account hormonal activity of majority of tumors, influencing the patients management tactic, the authors propose the insight on suprarenal tumor diagnosis of their own.

Carcinoma of parathyroid glands is characterized by relatively slow course, frequent recurrence after performance of operation. Authors were observed 8 patients, operated in 1967-2001, what had constituted 6% of all quantity of the primary hyperparathyroidism observations. Early diagnosis and performance of adequate surgical intervention promote the efficacy of treatment raising and the prognosis improvement. Most favourable prognosis was noted after performance of primary radical operation. In most observations the performance of reoperation guarantee long-lasting remission, but rarely constitutes the radical measure.

Essential approaches to the regional metastasizing rubric in TNM system were analyzed. Basing on summary of the results of 466 operations, performed for the thyroid gland cancer including intervention on cervical lymph nodes, the subgroup N alteration in international classification TNM was proposed, permitting to reflect individual clinical situation full to the brim and to achieve significant practical gain in further management of patient. The grading proposed corresponds to general principle, according to which every subsequent rubric must determine more severe affection without combining several types of affection in individual patient.

Results of reoperation for the thyroid gland cancer (THGC) were analyzed in 189 patients for 1981-2001 yrs period. Majority of patients were primarily operated in other hospitals of Ukraine. Thorough characteristic of the cancer forms, terms of reoperation performance, results of histological investigation of the tumor are adduced. Large frequency (41.2%) of the operation performance for THGC recurrences in term up to one years after performance of primary intervention trusts the necessity of operative intervention performance on thyroid gland (THG) in specialized centre by experienced surgeons. Absence of malignant growth in the THG stump while performance of definitive thyroidectomy in 60% of observations is not the cause to reject of doing it because the conduction of radioiodine therapy is possible after complete excision of the THG tissue. Examination and ultrasonographic investigation of the THG region and of cervical lymphatic nodes after performance of operation for THGC is recommended to conduct no less than once in 6 months.

The cytosol and microsomal fractions of human adrenal cortex contain 3 isoforms of protein kinase C: alpha, zeta, and epsilon. The latter fraction is present in trace amounts. No isoforms beta1, beta2, gamma and delta were found in these cell fractions. The distribution of alpha-isoform between the cytosol and microsomal fraction is determined by tissue origin: in normal tissue its content differs by no more than 10%, while in most tumors this isoform is translocated into the microsomal fraction. The distribution of zeta-isoform did not depend on tissue origin.

There was summarized the experience of treatment of the thyroid gland cancer, invading trachea (larynx) and other neighboring structures of the neck in 42 patients, whose state was estimated as severe one and neoplastic process--as nonoperable. Optimal surgical methods were applied depending on clinical signs of thyroidal carcinoma. In 36 patients the palliative resection of thyroid gland (in 6--with tracheostomy addition) was done, in 6--intervention was restricted by tracheostomy formation. The method of tracheostomy formation in cases of massive spreading of tumor along trachea is adduced.

The comparative analysis of immune state of the various age patients with benign and malignant thyroid gland (TG) tumors is presented. In the TG cancer the immunogenesis insufficiency is more pronounced. The data obtained trusts the perspectiveness of the immunocorrecting therapy application in patients with the TG cancer.

The state of calcium metabolism in 249 patients after performance of thyroidectomy was studied up. It was established that precisional technique of the surgical intervention performance directed on the parathyroid glands vascularization preservation, is the main prophylactic method for the parathyroid insufficiency occurrence. Indications for the parathyroid tissue autotransplantation application during the performance of thyroidectomy are substantiated.

In 1981-1998 years 552 children and juveniles were operated on for benign tumors of thyroid gland (TG). The enhancement of the revelation frequency of solitary and polynodous goiter and lowering of follicular adenoma and cystadenoma was noted. The tactics of children and juvenile patients with benign TG tumors was proposed, which included an early morphological verification of diagnosis, the puncture biopsy performance as well as intraoperative express-histological investigation. While solitary node in TG existence and preoperatively established its benign essence, extrafascial hemithyroidectomy, using original method, is the operative of choice.

Retrospective analysis of results of organpreserving operations for the thyroid gland cancer (TGC) in 55 children and juveniles for 1981-1997 yrs period was done. The informativity of preoperative cytological (96.4%) and intraoperative express--histological (95.6%) investigations was determined. In cases of the cytological and express--histological diagnosis complexities the possibility of organpreserving intervention of hemithyroidectomy with the isthmus extirpation was noted. Primary thyroidectomy is operation of choice in the established diagnosis of TGC.

Classification of operations on thyroid gland depending on the tissue volume preserved and basing on the analysis of surgical treatment of more than 2000 patients was presented. Substantiation and characteristics of its headings permits to take into account the intervention volume, what is peculiarly important during the automatized processing of large masses of information.

More then ten year follow up of 154 patients with Itsenko-Cushing disease (ICD) is presented, of whom in 69-one sided and in 89-bilateral transcatheteric transvenous adrenal glands destruction (TTAGD) was done. In 50% of them the remission of disease for a period of 5-10 years was observed.

The organ culture transplantation of the adrenals cortical substance of a newborn piglets was applied while 94 patients treatment to whom total adrenalectomy for Itsenko--Cushing disease was done. Significant lowering of the substitutional hormonal therapy (steroid preparations) dosage was permitted due to the noted improvement of hypocorticism clinical course and an organism hormonal security indexes. The clinical effect duration is 6-9 months. The methods physiologically substantiated, technically simple, economically advantageous, do not cause the side effects.

Laparoscopic adrenalectomy (LA) using transperitoneal lateral access was conducted in 56 patients from June 1994 to September 1996 yr. Unilateral adrenal gland tumor up to 8 cm in diameter was diagnosed in all the patients. All the patients are alive. LA is the method of choice in the patients with syndromes of Conn, Cushing, pheochromocytoma up to 8 cm in diameter. The LA conduction is not indicated if malignant or large (more than 8 cm in diameter) tumor was revealed.

Thyroid cancers in children from the affected areas of Ukraine were investigated by means of light (33 cases) and electron (20 cases) microscopy. Statistical data from 25 regions of Ukraine have been analyzed concerning thyroid cancer in patients aged up to 18 years for the period 1981-1990. There is an increase in the number of thyroid cancers in the children of Ukraine from 0.04-0.06 cases in the "pre-chernobyl" period to 0.23 cases per 10(5) children's population in 1990. In the children operated in the Clinic of the Institute of Endocrinology in 1990-1991, severe forms of thyroid lesions with metastases to the lymph nodes were noted. Histopathological studies show prevalence of different variants of papillary cancer with presence of follicular, solid, poorly differentiated areas. Ultrastructural analysis revealed polymorphism of tumour cells, various degrees of their differentiation and functional specialization that point to a mixed multicomponent nature of carcinomas.

A comparative analysis of the results of surgical treatment of 603 patients with malignant neoplasms of the thyroid gland before and after the accident at the Chernobyl atomic power station are presented. A very aggressive course of thyroid cancer in pediatric patients after the accident and the ensuing necessity to extend the indications for the performance of thyroidectomy with radical intervention on the regional lymph collectors are noted.

A new method was developed for therapy of Icenko-Cushing's disease using transcatheter transvenous destruction of the adrenals (TTDA) to replace commonly used adrenalectomy. TTDA was performed by means of venous extravasation of a radiopaque agent (76% verografin solution) and its deposition in the organ parenchyma. TTDA was performed in 57 patients with Icenko-Cushing's disease using 3 tactical approaches including roentgenovascular intervention: bilateral TTDA, unilateral TTDA combined with unilateral adrenalectomy and unilateral TTDA combined with chloditan. TTDA is an effective method of invasive suppression of function of the cortex of the endocrine glands. TTDA superiority over surgical methods of therapy Icenko-Cushing's disease is that an effect of adrenalectomy is achieved without a risk of surgical intervention and narcosis.

The results of surgical treatment of 4 patients with bilateral tumors of the adrenal cortical substance are presented. In 1 patient, glucosteronoma was revealed, in 2--malignant glucoandrosteronoma, in 1--nonfunctioning cancer. The patients with functioning tumors were operated on in two stages with the interval of 3-4 weeks. In 1 patient, 3 years after removal of the left adrenal gland for cancer, a tumor of the contralateral gland was removed. In removing the nonfunctional tumors and aldosteronomas, the median laparotomy is expedient, in glucosteronomas and glucoandrosteronomas--extraperitoneal lumbotomic approach. All the patients are alive 1.5-8 years after the operation.

The results are presented of the combined drug treatment of 39 patients with Icenko-Cushing's disease, using steroidogenesis inhibitor chloditane (o.p-DDD) and corticotropin secretion blocker peritol (cyproheptadine). The control group of 40 patients, suffered from the above disease of the same severity, was treated with alone chloditane. In the control group the inhibition of the adrenocortical glucocorticoid activity by chloditane was accompanied by twofold increase in the blood plasma corticotropin level. The relapse was noted in 24 of 40 patients after 5 to 6 months. The inhibition of glucocorticoid activity did not induce corticotropin secretion activation in patients, treated with chloditane and peritol. At the delayed terms of the treatment course the basal level of plasmatic corticotropin continued to lower and averaged the subnormal values. Relapses of the disease were seen in only 8 of 39 patients. The combined chloditane-perikol treatment of Icenko-Cushing's disease is likely to be perspective.

Altogether 28 patients with adrenocortical tumors (corticosteromas and corticoandrosteromas) were examined using a radioimmunoassay to determine the concentration of corticotropin, cortisol, blood cyclic nucleotides, the circadian rhythm and time course of corticotropin and cortisol levels against a background of insulin hypoglycemia. In patients with Itsenko-Cushing's syndrome the basel level of cortisol was notably raised, that of corticotropin was sharply decreased. The circadian rhythm of the levels of corticotropin and cortisol was disturbed, a response of the hypophyseal-adrenal system to a stressor was suppressed. The concentration of blood cyclic nucleotides was increased, and these changes were dependent on the nature of adrenal pathology.

To inhibit corticotropic function of the pituitary and glucocorticoid function of the adrenal cortex in the treatment of 41 patients with Icenko-Cushing's disease, use was made of the steroidogenesis inhibitor chloditane and high doses of reserpine. The treatment data were compared to the effect of chloditane alone in 40 patients. Inclusion of reserpine into the complex of therapeutic measures led to an appreciable decrease in corticotropin secretion which increased again shortly after the drug discontinuation. The clinical results of the treatment were comparable to those attained with administration of chloditane alone. The majority of patients manifested recurrent disease 3 to 12 months after the treatment was discontinued. Therefore, administration of reserpine as an additional means in the treatment was discontinued. Therefore, administration of reserpine as an additional means in the treatment of Icenko-Cushing's disease by chloditane with a view of a steady inhibition of corticotropic function of the pituitary and the prophylaxis of recurrencies is not desirable. High doses of reserpine may be recommended at the initial stages of the disease treatment in the presence of an extremely high level of blood plasma corticotropin.