S. Shikhmagomedov, D. V. Rebrova, M. A. Alekseev, L. M. Krasnov, E. A. Fedorov, I. K. Chinchuk, R. Chernikov, V. F. Rusakov, I. Sleptsov, I. Sablin, O. V. Kuleshov
BACKGROUND: Pheochromocytoma (PCC) is a tumor from the chromaffin tissue of the adrenal medulla, capable of hyperproduction of catecholamines. An important feature of pheochromocytoma, due to its hormonal activity, is the threat of sudden changes in hemodynamic parameters during surgical treatment. Retroperitoneoscopic access is currently becoming increasingly popular in the surgical treatment of chromaffin tumors of the adrenal glands. In clinical practice, two variants of the mentioned access are used: classic (three-port) and single-port. In this study, the influence of these options of retroperitoneoscopic access on intraoperative hemodynamic control was evaluated.AIM: Comparison of treatment results and intraoperative hemodynamic parameters of patients with adrenal pheochromocytomas operated with single-port and three-port retroperitonescopic access options.MATERIALS AND METHODS: A retrospective single-center cohort study was conducted on a sample of patients initially operated for pheochromocytoma at the Pirogov St. Petersburg State University High Medical Technology Clinic from October 2015 to February 2020 with intraoperative invasive hemodynamic control using PiCCO+ systems.RESULTS: 47 patients were examined, 24 of whom underwent single–port adrenalectomy (included in the first group), 23 — three-port (second group). The average tumor size in the second group was larger (40.12±9.3 and 56.7±21.5, p<0.05), presumably, in this regard, the average duration of surgery was statistically significantly higher (73±21.5 and 111.7±36.1, p<0.05). The body mass index (BMI) of patients in the two groups did not differ statistically significantly. Intraoperatively measured values of maximum and minimum mean systolic and diastolic blood pressure, the number of episodes of increased diastolic blood pressure above 120 mmHg and their duration did not differ statistically in both groups (p>0.05). Episodes of increased systolic blood pressure above 180 mm Hg were more frequent in the second group (p=0.03), but their total duration in the two groups was without significant differences (p>0.05). Intraoperative consumption of antihypertensive drugs during the release of the adrenal gland and vasopressor drugs after compression of the central vein of the adrenal gland were similar. Blood pressure after compression of the central vein in the first and second groups did not differ significantly (p>0.05). No deaths and postoperative complications were registered in both groups.CONCLUSION: Single-port modification of retroperitoneoscopic access with sufficient experience of the anesthesiological team and the operating surgeon does not lead to deterioration of hemodynamic control and operation results, being safe and effective in the surgical treatment of pheochromocytoma.
背景：嗜铬细胞瘤（PCC）是一种来自肾上腺髓质绒毛组织的肿瘤，能够过度分泌儿茶酚胺。由于嗜铬细胞瘤具有激素活性，它的一个重要特征是在手术治疗过程中可能出现血流动力学参数的突然变化。目前，腹膜后腔镜入路在肾上腺绒毛膜细胞瘤的手术治疗中越来越流行。在临床实践中，上述入路有两种变体：经典（三孔）和单孔。目的：比较单孔和三孔腹膜后入路肾上腺嗜铬细胞瘤患者的治疗效果和术中血流动力学参数。材料与方法：对2015年10月至2020年2月期间在皮拉戈夫-圣彼得堡国立大学高等医学技术诊所接受嗜铬细胞瘤初次手术的患者样本进行了回顾性单中心队列研究，术中使用PiCCO+系统进行有创血流动力学控制。结果：47名患者接受了检查，其中24人接受了单孔肾上腺切除术（第一组），23人接受了三孔肾上腺切除术（第二组）。第二组的平均肿瘤大小更大（40.12±9.3 和 56.7±21.5，P0.05）。第二组的收缩压升高超过 180 mm Hg 的情况更频繁（P=0.03），但两组的总持续时间无显著差异（P>0.05）。释放肾上腺时的术中降压药物用量和压迫肾上腺中心静脉后的血管加压药物用量相似。第一组和第二组压迫中心静脉后的血压没有明显差异（P>0.05）。结论：在麻醉团队和手术医生有足够经验的情况下，单孔腹膜后腔镜入路的改造不会导致血流动力学控制和手术效果的恶化，在嗜铬细胞瘤的手术治疗中安全有效。
{"title":"Comparison of intraoperative hemodynamics in classical and single-port adrenalectomy","authors":"S. Shikhmagomedov, D. V. Rebrova, M. A. Alekseev, L. M. Krasnov, E. A. Fedorov, I. K. Chinchuk, R. Chernikov, V. F. Rusakov, I. Sleptsov, I. Sablin, O. V. Kuleshov","doi":"10.14341/serg12837","DOIUrl":"https://doi.org/10.14341/serg12837","url":null,"abstract":"BACKGROUND: Pheochromocytoma (PCC) is a tumor from the chromaffin tissue of the adrenal medulla, capable of hyperproduction of catecholamines. An important feature of pheochromocytoma, due to its hormonal activity, is the threat of sudden changes in hemodynamic parameters during surgical treatment. Retroperitoneoscopic access is currently becoming increasingly popular in the surgical treatment of chromaffin tumors of the adrenal glands. In clinical practice, two variants of the mentioned access are used: classic (three-port) and single-port. In this study, the influence of these options of retroperitoneoscopic access on intraoperative hemodynamic control was evaluated.AIM: Comparison of treatment results and intraoperative hemodynamic parameters of patients with adrenal pheochromocytomas operated with single-port and three-port retroperitonescopic access options.MATERIALS AND METHODS: A retrospective single-center cohort study was conducted on a sample of patients initially operated for pheochromocytoma at the Pirogov St. Petersburg State University High Medical Technology Clinic from October 2015 to February 2020 with intraoperative invasive hemodynamic control using PiCCO+ systems.RESULTS: 47 patients were examined, 24 of whom underwent single–port adrenalectomy (included in the first group), 23 — three-port (second group). The average tumor size in the second group was larger (40.12±9.3 and 56.7±21.5, p<0.05), presumably, in this regard, the average duration of surgery was statistically significantly higher (73±21.5 and 111.7±36.1, p<0.05). The body mass index (BMI) of patients in the two groups did not differ statistically significantly. Intraoperatively measured values of maximum and minimum mean systolic and diastolic blood pressure, the number of episodes of increased diastolic blood pressure above 120 mmHg and their duration did not differ statistically in both groups (p>0.05). Episodes of increased systolic blood pressure above 180 mm Hg were more frequent in the second group (p=0.03), but their total duration in the two groups was without significant differences (p>0.05). Intraoperative consumption of antihypertensive drugs during the release of the adrenal gland and vasopressor drugs after compression of the central vein of the adrenal gland were similar. Blood pressure after compression of the central vein in the first and second groups did not differ significantly (p>0.05). No deaths and postoperative complications were registered in both groups.CONCLUSION: Single-port modification of retroperitoneoscopic access with sufficient experience of the anesthesiological team and the operating surgeon does not lead to deterioration of hemodynamic control and operation results, being safe and effective in the surgical treatment of pheochromocytoma.","PeriodicalId":518511,"journal":{"name":"Endocrine Surgery","volume":"37 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141818458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. V. Kovaleva, A. K. Eremkina, I. Maganeva, S. S. Mirnaya, I. V. Kim, N. S. Kuznetzov, E. Andreeva, T. L. Karonova, I. V. Kryukova, A. M. Mudunov, I. V. Sleptcov, G. Mel’nichenko, N. Mokrysheva
Hypoparathyroidism is an endocrine disease characterized by reduced production of parathyroid hormone by the parathyroid glands or tissue resistance to its action. This is accompanied by disturbances in phosphorus-calcium metabolism.The main cause of hypoparathyroidism is damage or removal of the parathyroid glands during surgery on the neck organs. Autoimmune hypoparathyroidism is the second most common form of the disease, which occurs, as a rule, within the autoimmune polyglandular syndrome type 1.The development of chronic hypoparathyroidism of any etiology requires lifelong appointment of multicomponent therapy, as well as careful monitoring and an individual approach. In the absence of adequate dynamic monitoring, multiple complications develop from vital organs, in particular calcification of the urinary system, soft tissues and the brain; cardiovascular pathology; visual disturbances; muscle and bone diseases leading to decreased quality of life of patients.Thus, timely diagnosis, rationally selected drug therapy and competent patient management will reduce the risks of complications, improve the prognosis, and reduce the frequency of hospitalizations and disability of patients with chronic hypoparathyroidism.The article presents the main recommendations of the new project of clinical guidelines for patients with hypoparathyroidism, approved by the Ministry of Health of the Russian Federation in 2021. They include the algorithms of diagnosis, treatment and dynamic monitoring of hypoparathyroidism, as well as management of postsurgical hypocalcemia and medical care of and the disease during pregnancy.
{"title":"Review of clinical practice guidelines for hypoparathyroidism","authors":"E. V. Kovaleva, A. K. Eremkina, I. Maganeva, S. S. Mirnaya, I. V. Kim, N. S. Kuznetzov, E. Andreeva, T. L. Karonova, I. V. Kryukova, A. M. Mudunov, I. V. Sleptcov, G. Mel’nichenko, N. Mokrysheva","doi":"10.14341/serg12950","DOIUrl":"https://doi.org/10.14341/serg12950","url":null,"abstract":"Hypoparathyroidism is an endocrine disease characterized by reduced production of parathyroid hormone by the parathyroid glands or tissue resistance to its action. This is accompanied by disturbances in phosphorus-calcium metabolism.The main cause of hypoparathyroidism is damage or removal of the parathyroid glands during surgery on the neck organs. Autoimmune hypoparathyroidism is the second most common form of the disease, which occurs, as a rule, within the autoimmune polyglandular syndrome type 1.The development of chronic hypoparathyroidism of any etiology requires lifelong appointment of multicomponent therapy, as well as careful monitoring and an individual approach. In the absence of adequate dynamic monitoring, multiple complications develop from vital organs, in particular calcification of the urinary system, soft tissues and the brain; cardiovascular pathology; visual disturbances; muscle and bone diseases leading to decreased quality of life of patients.Thus, timely diagnosis, rationally selected drug therapy and competent patient management will reduce the risks of complications, improve the prognosis, and reduce the frequency of hospitalizations and disability of patients with chronic hypoparathyroidism.The article presents the main recommendations of the new project of clinical guidelines for patients with hypoparathyroidism, approved by the Ministry of Health of the Russian Federation in 2021. They include the algorithms of diagnosis, treatment and dynamic monitoring of hypoparathyroidism, as well as management of postsurgical hypocalcemia and medical care of and the disease during pregnancy.","PeriodicalId":518511,"journal":{"name":"Endocrine Surgery","volume":"44 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141818151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ya. V. Dvoryanchikov, A. Y. Tokmakova, G. Galstyan, M. S. Sheremeta, A. A. Trukhin
According to modern concepts, Charcot’s neuro-osteoarthropathy (Charcot’s foot) is considered as an aseptic inflammatory process in individuals with distal polyneuropathy, which leads to damage to bones and joints. Most often, Charcot’s foot is formed in patients with diabetes mellitus (DM) and affects the foot and ankle joint. Diabetic neuroosteoarthropathy (DNOAP) is divided into active and inactive stages. The typical clinical picture of the active stage of diabetic neuroosteoarthropathy is edema and hyperemia of the affected foot, with a temperature gradient of more than 2 °C compared with an unaffected foot. The nonspecific clinical picture of the active stage of diabetic neuroosteoarthropathy makes it difficult to diagnose and often leads to the need for differential diagnosis of the active stage of diabetic neuroosteoarthropathy and osteomyelitis, which is one of the most difficult issues in clinical practice. Early detection of these conditions is crucial, since treatment of the active stage of diabetic neuroosteoarthropathy can prevent irreversible deformity of the foot, and detection of osteomyelitis will allow timely antibiotic therapy. Signs of changes in bone and foot structures in the active stage of diabetic neuroosteoarthropathy in images obtained by computer X-ray, magnetic resonance and emission tomography may be similar to signs of osteomyelitis, which determines the importance of choosing an imaging method when examining a patient and developing an effective algorithm for early diagnosis of DNOAP. In this review, the main attention will be paid to the distinctive features of the active stage of diabetic neuroosteoarthropathy and osteomyelitis when using imaging research methods.
根据现代概念，夏科氏神经骨关节病（夏科氏足）被认为是远端多发性神经病患者的一种无菌性炎症过程，会导致骨骼和关节受损。沙尔科氏足多见于糖尿病（DM）患者，影响足部和踝关节。糖尿病神经骨关节病（DNOAP）分为活动期和非活动期。糖尿病神经性骨关节病活动期的典型临床表现是患足水肿和充血，与未受影响的足相比，温度梯度超过 2°C。糖尿病神经性关节病活动期的临床表现无特异性，因此很难诊断，往往需要对糖尿病神经性关节病活动期和骨髓炎进行鉴别诊断，这是临床实践中最棘手的问题之一。早期发现这些病症至关重要，因为治疗处于活动期的糖尿病神经性关节病可以防止足部出现不可逆转的畸形，而发现骨髓炎则可以及时进行抗生素治疗。在糖尿病神经性关节病的活动期，计算机 X 射线、磁共振和发射断层扫描获得的图像中骨和足部结构的变化迹象可能与骨髓炎的迹象相似，这就决定了在检查患者时选择成像方法和制定早期诊断 DNOAP 的有效算法的重要性。在这篇综述中，将主要关注在使用影像学研究方法时，糖尿病神经性关节病和骨髓炎活动期的明显特征。
{"title":"Differential diagnosis of diabetic neuroosteoarthropathy and osteomyelitis using medical imaging techniques","authors":"Ya. V. Dvoryanchikov, A. Y. Tokmakova, G. Galstyan, M. S. Sheremeta, A. A. Trukhin","doi":"10.14341/serg12842","DOIUrl":"https://doi.org/10.14341/serg12842","url":null,"abstract":"According to modern concepts, Charcot’s neuro-osteoarthropathy (Charcot’s foot) is considered as an aseptic inflammatory process in individuals with distal polyneuropathy, which leads to damage to bones and joints. Most often, Charcot’s foot is formed in patients with diabetes mellitus (DM) and affects the foot and ankle joint. Diabetic neuroosteoarthropathy (DNOAP) is divided into active and inactive stages. The typical clinical picture of the active stage of diabetic neuroosteoarthropathy is edema and hyperemia of the affected foot, with a temperature gradient of more than 2 °C compared with an unaffected foot. The nonspecific clinical picture of the active stage of diabetic neuroosteoarthropathy makes it difficult to diagnose and often leads to the need for differential diagnosis of the active stage of diabetic neuroosteoarthropathy and osteomyelitis, which is one of the most difficult issues in clinical practice. Early detection of these conditions is crucial, since treatment of the active stage of diabetic neuroosteoarthropathy can prevent irreversible deformity of the foot, and detection of osteomyelitis will allow timely antibiotic therapy. Signs of changes in bone and foot structures in the active stage of diabetic neuroosteoarthropathy in images obtained by computer X-ray, magnetic resonance and emission tomography may be similar to signs of osteomyelitis, which determines the importance of choosing an imaging method when examining a patient and developing an effective algorithm for early diagnosis of DNOAP. In this review, the main attention will be paid to the distinctive features of the active stage of diabetic neuroosteoarthropathy and osteomyelitis when using imaging research methods.","PeriodicalId":518511,"journal":{"name":"Endocrine Surgery","volume":"43 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141818028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In memory of Bubnov Alexander Nikolaevich (26.07.1939 — 18.09.2023)","authors":"R. A. Chernikov","doi":"10.14341/serg12938","DOIUrl":"https://doi.org/10.14341/serg12938","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":518511,"journal":{"name":"Endocrine Surgery","volume":"86 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140528310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. S. Podshivalova, E. A. Vetchinkina, T. V. Pogoda, M. V. Utkina
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{"title":"Diagnosis of mutations in the CYP21A2 gene","authors":"E. S. Podshivalova, E. A. Vetchinkina, T. V. Pogoda, M. V. Utkina","doi":"10.14341/serg12902","DOIUrl":"https://doi.org/10.14341/serg12902","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":518511,"journal":{"name":"Endocrine Surgery","volume":"238 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140531429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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