Endocrine Surgery

Клинические рекомендации по ведению больных с нейроэндокринными опухолями дистальной части тонкой (тощей и подвздошной) кишки выработаны группой международных экспертов и освещают обновление эпидемиологических данных, пересмотр различных параметров классификации опухолей (ВОЗ, гистологические критерии, TNM), а также мультидисциплинарные проблемы, связанные с различными вопросами диагностики, стадирования и выбора оптимальных методов лечения больных с нейроэндокринными опухолями указанной локализации. Полный текст рекомендаций: B. Eriksson, G. Kloppel, E. Krennin, H. Ahlman, U. Plоckinger, B. Wiedenmann, R. Arnold, C. Auernhammer, M. Kоrner, G. Rindi, S. Wildi et al. Neuroendocrinology. 2008;87:8–19.

Medullary thyroid cancer (MTC) has high level of clinical aggressiveness as well as high recurrence rate par& ticularly metastases in regional lymph nodes. Surgery is single curative treatment method thus only initial appropriate operation volume could improve disease&free and overall survival. In our study the experience of surgical treatment of 125 MTC patients is analyzing. In 25% of cases there were familial MTC (germline RET/MTC mutation verified) disease and in 75% – sporadic tumors. Comparison of ten&years disease&free sur& vival in two groups with various initial surgery extensions revealed that thyroidectomy associated with central neck dissection as a minimal operation volume has significantly improved long&term disease&free survival as against to lesser initial surgery extension.

Aim: to analyze treatment results in patients with neuroischemic diabetic foot referred to vascular clinics for revascularization.Methods: Follow-up data of 88 consecutive outpatients with neuroischemic diabetic foot ulcers or postsurgery wounds were analyzed. Initially the patients received treatment in one outpatient diabetic foot clinic form 1st March to 30th June 2010. As conservative ulcer / wound treatment during 3–4 weeks was not effective, all they were referred to vascular surgeon / endovascular specialist consultation in several Moscow hospitals. Data were collected on follow-up visits to the foot clinic or by phone. Median follow-up time was 16 months (3 mo – 2.5 yrs).Results: Of 88 referred, revascularization procedures were performed in 38 patients (21 – endovascular, 17 – bypass surgery). 18 patients were considered as inoperable and 24 refused of vascular specialist consultation or treatment. Ulcer treatment results were satisfactory (primary healing or healing after minor amputation) in59% of revascularized patients, in 33% of inoperable ones and in 32% of those who refused of revascularization. Patients’ refusal rate of vascular intervention was higher in a period of time when treatment appeared to be less successful due to several reasons. Later treatment results were improved and refusal rate decreased. Conclusions: (1) nowadays revascularization is relatively available for diabetic foot patients in Moscow; (2) more than 2/3 of non-revascularized patients have unsuccessful results of ulcer treatment, vascular intervention improves results significantly; (3) revascularization does not increase mortality in elderly patients with neuroischemic diabetic foot; (4) following is necessary for improvement of revascularization efficacy: active combination of bypass surgery and endovascular interventions, considering of pulsatile blood flow in all vascular bed segments as an aim of intervention and close interdisciplinary collaboration