Evaluation of tissue blood supply during esophagectomy using fluorescent diagnostics and diffuse scattering spectroscopy in visible region

BACKGROUND

The success of the surgical treatment of a tumor or obstruction of the esophagus with subsequent anastomosis application depends on the level of blood supply to the stitched tissues. Intraoperative assessment of blood flow is widely used in medicine and can be used as a diagnostic method that affects the outcome of surgery and reduces the frequency of postoperative complications for the patient.

METHODS

In this work, the assessment of blood supply during esophageal resection operations was carried out using two techniques sequentially: fluorescent diagnostics with indocyanine green and measurement of hemoglobin oxygen saturation by diffuse scattering spectroscopy in the visible wavelength range. The first method was used to assess the integrity of the vascular network structure in the area of anastomosis and blood flow through the sutured tissues, the second one - for local assessment of hemoglobin oxygen saturation in the investigated area.

RESULTS

Conducted clinical study involved the participation of nine patients with malignant neoplasms (six cases) or esophageal obstruction (three cases). The presence of postoperative complications was compared with the measurement results. Anastomosis failure was observed in only one patient. According to the results of the study, with the use of the investigated method of assessing blood supply, there is a tendency towards a decrease in the frequency of anastomosis leaks (11.1 % compared with 21.4 %).

CONCLUSIONS

Therefore, fluorescent diagnostics with indocyanine green and measurement of hemoglobin oxygen saturation using diffuse scattering spectroscopy were affirmed as methods that allow increasing the safety of surgical procedures by assessing the risk of postoperative complications, including anastomosis failures.

New approaches to diagnostics and treatment of cholangiocellular cancer based on photonics methods

Cholangiocellular cancer (CCC) is an oncological disease of the bile ducts characterized by a high mortality rate. To date, the use of standard methods for the diagnosis and treatment of CCC has not been able to reduce mortality from this disease. This work presents the results of fluorescence diagnostics (FD), which consists in using a modified optical fiber and photodynamic therapy (PDT) using a therapeutic laser instead of a low-intensity laser. This technique was tested on 43 patients in a clinical setting. The results obtained indicate a direct correlation between spectroscopic and video FD methods. Furthermore, a direct correlation was found between the photobleaching of a chlorin e6-based photosensitizer, with the commercial names of Photolon Radachlorin and Photoran and stricture regression. Our findings demonstrate the possibility of using a therapeutic laser with a wavelength of 660 nm for both diagnosis and treatment of bile ducts cancer, which results in a significant reduction of the operation time without decreasing its effectiveness.

Telomerase activity in the differential diagnosis of pancreatic mass

BACKGROUND

In this manuscript, we show that the detection of telomerase activity in pancreatic mass tissue provides early evidence of a cancerous process that requires a well-timed surgical treatment.

METHODS

Eighty-eight patients with pancreatic mass (both benign and malignant) were involved in the research. Comparative analyses of the data and instrumental methods to define the histological structure of tumor mass and measure telomerase activity have been carried out.

RESULTS

Intense telomerase activity (+++) in the tissue of pancreatic mass determines cancer with high accuracy. One hundred percent of patients with pancreatic cancer had high telomerase activity. In 32.4% of patients with average telomerase activity (++) pancreatic cancer was diagnosed. The average telomerase activity (++) in pancreatic tumors gives an early indication of pancreatic cancer and requires dynamic observation for 6 to 12 months (P<0.05). Low telomerase activity (+) in patients with benign tumors is an accurate sign for confirming a diagnosis.

CONCLUSIONS

The detection of telomerase activity in pancreatic mass tissue provides early evidence of a cancerous process that requires a well-timed surgical treatment.

[Massive abdominal hydatidosis]

Clinical symptoms and localization of echinococcosis are various. Clinical observation of successful surgical treatment of secondary multiple abdominal lesion with echinococcosis is presented in the article. Certain features of diagnosis and surgical treatment are described.

[Surgical treatment of ACTH-ectopic syndrome]

ACTH-ectopic syndrome is a severe, multiple-symptom disease characterized by secretion of adrenocorticotropic hormone (ACTH) by ectopic tumor, increased release of adrenal cortical hormones and clinical picture of hypercorticism. Diagnosis and treatment of ACTH-ectopic syndrome is still difficult problem despite the achievements of modern medicine. There are several unresolved issues including optimal diagnostic algorithm, indications for various surgical procedures and their optimal dates. This review is devoted to these questions.

[Echinococcosis and pregnancy: approaches to the treatment]

AIM

To develop treatment strategy in pregnant women with liver echinococcosis.

MATERIAL AND METHODS

There were 21 women with confirmed diagnosis of liver echinococcosis who were divided into 2 groups. Group I consisted of 17 patients with cysts Charbi grade I-III. They underwent percutaneous puncture and antiparasitic management of the cyst under intravenous sedation. Group II included 4 patients with cysts grade IV-V and those with multiple cysts. They underwent conventional surgery.

RESULTS

In one patient, fetal death occurred in 20 hours after surgery and it was not associated with the procedure. There were no complications in other patients. Uneventful childbirth was noted in all of them.

CONCLUSION

Percutaneous puncture in the second trimester of pregnancy is effective and safe procedure for prevention of complications of echinococcosis in late pregnancy and childbirth. Conventional surgery is alternative if percutaneous intervention is not advisable.

[The use of Octreotide-depo for the pancreatitis' prophylaxis after radical surgery of gastric cancer with lymphadenectomy]

The efficacy of the medicamentous prophylaxis of the acute postoperative pancreatitis (APP) was estimated in 594 patients. They all were divided into 3 groups: 1st was treated with octreotide, 2nd - with octreotide-depo, 3rd - with 5-ftoruracil and dalargin. Patients of the 3rd group showed the highest levels of α-amylase in both blood and drainage fluid during the early postoperative period. The frequency and severity of postoperative complication rates were the lowest in those patients, who received octreotide-depo and was 3,06%; whereas among patients of the 2nd group it was 16,8% and among those, who were treated with 5-ftoruracil and dalargin, it was 22,4%. The destructive forms of pancreatitis were registered in 2nd and 3rd groups in 1 and 3 patients, respectively. Intraabdominal abscesses were registered in 1 patient of the 1st and 6 patients of the 3rd group, respectively. The lethality rate was 0.9% in the 1st group; 1.02% in the 2nd and 1.8% in the 3rd group. The use of somatostatine analogues in the prophylaxis of postoperative complications proved to decrease overall complications' rate and, first of all, the rate of postoperative destructive pancreatitis. The use of the prolonged forms of somatostatine analogues, i.e., octreotide depo 10 mg is considered to be highly effective.

[Capacities of diagnostic volumetric multislice spiral computed tomography in the diagnosis of gastric cancer]

In the period 2009 to 2010, diagnostic multislice spiral computed tomography (MSCT) was carried out in 49 patients with gastric cancer. The efficiency of dynamic MSCT in detecting a tumor and determining its locoregional extent was evaluated. The results of dynamic MSCT were compared with those of postoperative histological examination. The possibility of detecting gastric cancer by dynamic MSCT was ascertained to depend on the depth of tumor invasion and to average 29, 71, 72, and 77% for T1, T2, T3, and T4, respectively. Dynamic MSCT showed a correlation between the frequency of metastatic lesion and the sizes of lymph nodes (r = 0.54; p = 0.0001) and their number (r = 0.82; p < 0.0001).