This consensus outlines the key information regarding the course of the disease and treatment approaches for patients with pituitary adenomas. A multidisciplinary team of specialists, including a neurosurgeon, an endocrinologist, and a radiotherapist, carries out the management of this patient group. The document details the current understanding of the course of the disease and treatment methods for somatotroph, corticotroph, prolactin-secreting, thyrotroph, and clinically non-functioning pituitary adenomas. The applied treatment modalities include surgical, medical, and radiotherapeutic approaches. The choice of strategy depends on hormonal activity, tumor size, direction of growth, the severity of mass effect, and the presence of somatoneurological complications. Patients should be followed by specialists with the appropriate expertise to diagnose and manage the full spectrum of pituitary adenomas. Upon diagnosis of a pituitary adenoma, consultation with a neurosurgeon, radiologist, and radiotherapist is recommended to exclude meningiomas, craniopharyngiomas, and other neoplasms of the sellar region. For all patients with acromegaly who are candidates for neurosurgical treatment, surgery is recommended to be performed at medical centers specializing in pituitary disorders. In the vast majority of cases, medical therapy for acromegaly is recommended as second-line therapy. Radiotherapy constitutes the third line of treatment for acromegaly. The treatment of Cushing’s disease involves surgical, medical, and radiotherapeutic interventions. First-line treatment consists of endoscopic transnasal adenomectomy performed at an expert-level center. In cases where surgery is ineffective, repeat surgery may be considered. Medical therapy or radiotherapy are used as second-line options. In life-threatening hypercortisolism, bilateral adrenalectomy is performed. The management of prolactin-secreting adenomas involves three main methods: medical, surgical, and radiotherapeutic. Medical therapy is the preferred treatment modality. Surgery is not the treatment of choice for prolactinomas. Adenomectomy is recommended for patients with intolerance or resistance to conservative therapy, or when absolute indications are present. Upon confirmation of a thyrotropinoma diagnosis, endoscopic transnasal adenomectomy is performed in a specialized medical facility. If surgery is not feasible or for preoperative preparation, somatostatin analogs are used. Thyrostatic agents are not indicated. For clinically non-functioning pituitary adenomas, surgical treatment is indicated in the presence of: visual field deficits and decreased visual acuity caused by compression of the optic chiasm and optic tracts; oculomotor disturbances such as ophthalmoplegia, diplopia, or other neurological disorders resulting from pathological compression of adjacent neural structures; pituitary apoplexy with visual disturbances; impaired cerebrospinal fluid outflow, hydrocephalus, and intracranial hypertension caused by tumor extension into the third ventricle; CSF rhinorrhea resulting from tumor-induced destruction of the diaphragm and the floor of the sella turcica.
BACKGROUND. Obesity is associated with a decrease in ovarian reserve in women of reproductive age, which contributes to the development of infertility. It is assumed that weight loss may improve female fertility. Bariatric surgery is the most effective treatment for morbid obesity; however, data on its impact on ovarian reserve parameters remain limited and conflicting. AIM. To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on ovarian reserve markers in women of reproductive age with obesity. MATERIALS AND METHODS. Women aged 18 to 40 years underwent anthropometric assessments, evaluation of carbohydrate metabolism, and indirect ovarian reserve parameters (plasma anti-Müllerian hormone [AMH] and antral follicle count [AFC]) at baseline and 12 months after LSG. According to the level of AMH after LSG, patients were divided into two groups: Group 1 — women with AMH <1.1 ng/mL, indicating a decrease in ovarian reserve (n=19), Group 2 — those with AMH ≥1.1 ng/mL (n=30). RESULTS . The study included 49 women with a median age of 31.0 [29.0–33.0] years. 12 months after LSG, all participants achieved weight loss and improved carbohydrate metabolism parameters. Initially, the AMH in all women were ≥1.1 ng/mL, which indirectly indicates a preserved ovarian reserve. Plasma AMH levels increased from 2.2 [1.5–3.0] ng/ml to 2.5 [0.9–3.0] ng/ml after LSG, but this change was not statistically significant. Both groups, stratified by postoperative AMH dynamics, were comparable in age. Group 1 (demonstrating postoperative AMH reduction) exhibited significantly higher body mass index (BMI) and HOMA-IR values both pre- and postoperatively, along with a more prolonged history of obesity. These patients also presented with lower baseline AMH and AFC values, with all patients (100%) reporting maternal history of early or premature menopause. Correlation analysis revealed an inverse relationship between postoperative AMH and baseline BMI, BMI dynamics after breast cancer, HOMA-IR index before and after surgery, as well as with the duration of obesity. At the same time, a direct correlation was found between postoperative AMH and preoperative AMH levels, as well as with AFC before and after the intervention. Correlation analysis demonstrated significant inverse associations between postoperative AMH levels and: preoperative BMI, postoperative BMI reduction, preoperative and postoperative HOMA-IR indices, and duration of obesity. Conversely, we observed positive correlations between postoperative AMH and both preoperative AMH levels and AFC measurements obtained before and after the surgical intervention. CONCLUSION. The impact of LSG on ovarian reserve in reproductive-age women remains insufficiently studied. The observed decline in ovarian reserve markers in some patients highlights the need for further research to optimize personalized treatment strategies for obese women of childbearing age.
BACKGROUND: The most aggressive head and neck malignant tumours are still a great medical and social problem due to the known difficulties both at the diagnostic stage and in the choice of molecular-personalized treatment strategy. The most rapid and accurate morphological (histological, immunohistochemical, molecular genetic) diagnosis is of fundamental importance. Fine-needle aspiration biopsy is often insufficient for these tasks, particularly in large, rapidly growing tumors and after radiotherapy, when pronounced fibrosis reduces the diagnostic yield of cytology. An alternative to incisional biopsy — which carries anesthetic risks in patients with bulky cervical tumor masses — is core needle biopsy, which enables procurement of representative tissue cores for comprehensive histologic, immunohistochemical, and molecular-genetic studies within a short timeframe. AIM: To evaluate the diagnostic yield, clinical utility, and safety of core needle biopsy in the workup of anaplastic thyroid carcinoma, lymphoproliferative disorders, and other aggressive neck tumors, including the feasibility of performing valid histologic, immunohistochemical, and molecular-genetic assays on the obtained material and the impact of the results on initial therapeutic decision-making. MATERIALS AND METHODS: In the period 2017–2025, a total of 131 core needle biopsies were performed at Saint-Petersburg State University for patients with anaplastic thyroid carcinoma, lymphoproliferative diseases and other aggressive tumours. The technique of core needle biopsy of neck tumours is described in detail. RESULTS: Among all patients who underwent core needle biopsy, on the basis of histological and immunohistochemical methods the diagnosis of anaplastic carcinoma was established in 79 patients (60.3%), lymphoma — in 22 patients (16.8%), other tumours and non-tumours — in 30 patients (22.9%). According to the data of genetic studies, BRAFV600E mutation was detected in 27 patients with anaplastic carcinoma, one mutation in NRAS codon 61 of Q61K type (181C>A); one case of mutation in NTRK3 gene (ex15) was detected. CONCLUSION: Core needle biopsy of thyroid, neck tumours and neck lymph nodes is a simple, minimally invasive and effective intervention with high informative and diagnostic value. The advantage of this method is the possibility of obtaining sufficient material to study the structural and cellular characteristics of the tumour, to perform valid immunohistochemical and molecular genetic studies.
Papillary thyroid carcinoma (PTC) is the most common form of differentiated thyroid cancer and it is generally characterized by an indolent course. The role of the ability to invade blood vessels and its impact on the prognosis in PTC remain uncertain. The authors conducted an electronic search of publications within the PubMed database. A number of studies demonstrate angioinvasion ceasing to be an independent factor of poor prognosis upon multivariate analysis. The existence of conflicting data on the prognostic role of angioinvasion in PTC may be explained by the difficulty in differentiating between blood vessel and lymphatic vessel invasion, as well as by the use of different criteria for true angioinvasion during morphological examination of surgical specimens. Literature data on the prognostic role of the extent of blood vessel invasion in PTC are limited to a few studies and do not allow for conclusions to be drawn regarding any threshold value for risk of recurrence stratification. When examining tumors of larger size, the dependence of the number of detected invasion foci on the number of examined tumor sections becomes particularly relevant. The issue of the prognostic value of angioinvasion as a risk factor for recurrence and progression of PTC, and as a possible basis for choosing more aggressive treatment tactics, requires further investigation.
INTRODUCTION. A leydigoma is a hormone-active tumor that develops from Leydig cells that produce testosterone. Excessive production of testosterone by the tumor in pre-puberty boys leads to gonadotropin-independent premature puberty. The main treatment method for leydigoma is surgical. The volume of surgical intervention remains the subject of discussion. DESCRIPTION OF THE CLINICAL CASE. A patient aged 4 years and 7 months was admitted complaining of an increase in the size of the right testicle and penis for one and a half year and progressive hair growth at the base of the penis for two months. An increase in testosterone secretion, echographic signs of bulky formation of the right testicle and negative indicators of cancer markers were revealed at the place of residence. As a result of the examination, a leydigoma of the right testicle was suspected. In order to exclude the malignant process, computed tomography of the abdominal cavity, retroperitoneal space and small pelvis with X-ray contrast enhancement was performed. No volumetric formations or foci pathologically accumulating contrast agent in the abdominal cavity and retroperitoneal space were detected. A scrototomy and removal of the tumor of the right testicle were performed. CONCLUSION. Leydigoma is a testicular disease that is accompanied by a clinic of premature puberty. The rarity of this pathology has a significant impact on the timing of diagnosis. They are usually late, which entails irreversible changes that appear in the patient's body due to prolonged hypersecretion of testosterone. The main treatment method is surgical. The choice of surgical tactics is justified by the size of the tumor and the risk of malignancy. Patients require long-term follow-up due to the risk of developing premature gonadotropin-dependent puberty and its consequences.
Metastatic lesions of the thyroid gland are extremely rare: in the English-language literature, only 24 clinical cases of colorectal cancer metastasis to the thyroid gland were previously reported. We present a rare clinical case of metastatic thyroid carcinomatosis in a 39-year-old female patient who underwent combined treatment for rectal cancer. In 2018, the patient underwent a laparoscopic-assisted anterior resection of the rectum, with extended lymphadenectomy and preventive ileostomy for rectal cancer (adenocarcinoma), followed by 8 courses of chemotherapy. For the first time, a node in the right lobe of the thyroid gland was detected in August 2020, at the same time a fine-needle aspiration biopsy was performed, the cyto logical picture of which was characteristic of papillary carcinoma, class VI according to Bethesda. In September 2020, the patient underwent surgery in the amount of thyroidectomy, lymphadenectomy III, IV, VI levels of the neck on the right. In order to clarify the histogenesis of tumor foci, an immunohistochemical study was performed (SK-7, SK-20, CDX-2 (DAK-CDX-2), SATB-2 (EP281)). Histological examination of the right lobe of the thyroid gland revealed a metastasis of low-grade adenocarcinoma of the intestinal type with a desmoplastic reaction of the stroma, extensive foci of necrosis, and tumor thrombi in the lumen of blood and lymphatic vessels. In 3 lymph nodes, metastases of poorly differentiated adenocarcinoma with subtotal replacement of lymph node tissue were also detected.
Hypoglycemic syndrome (HGS) is a symptom complex that develops due to an imbalance in the blood glucose maintenance system with the development of hypoglycemia and is stopped by the administration of glucose. One of the most relevant methods at the present stage for the diagnosis of hereditary causes of HGS is whole exome sequencing. The description of two cases in the same family (mother and daughter) is presented, when using whole exome sequencing with the study of genes responsible for HGS, it became possible to establish an accurate diagnosis of a combined hereditary pathology (multi ple endocrine neoplasia type 1 syndrome (MEN1) and maturity-onset diabetes of the young 12 (MODY12)) and to determine a clear management strategy for patients. The presented family case highlights the importance of an extended genetic examination for an accurate diagnosis of the disease; confirms the need for MEN1 gene sequencing in young patients of the risk group, even if primary hyperparathyroidism has not yet manifested in them; once again demonstrates the variability of phenotypic penetrance of hereditary diseases (in particular MEN1 and MODY12); It recalls the expediency of considering the use of in vitro fertilization with preimplantation genetic testing in order to prevent the transmission of hereditary diseases to offspring; highlights the complexities of imaging diagnostics of neuroendocrine tumors
BACKGROUND . A feature of papillary thyroid carcinomas is the frequent lymphogenic spread. First of all, the lymph nodes of the central zone are affected. According to current clinical guidelines, preventive lymphodissection is currently not indicated. At the same time, the detection of "hidden" metastases can lead to a change in the stage of the disease, stratification of the risk group for recurrence, and influence treatment tactics. Our study is aimed at identifying the key factors influencing metastasis to the lymph nodes of the IV neck group. AIM: The study is aimed at identifying key factors influencing metastasis to the lymph nodes of the sixth group of the neck in the initial stages of papillary thyroid cancer. MATERIALS AND METHODS . A single-center uncontrolled study was conducted, including 319 patients with papillary thyroid cancer without clinical signs of regional lymph node metastasis (T1-2N0M0, stage I). All patients underwent thyroidectomy with preventive central cervical lymphodissection. RESULTS. Among 319 patients, a "hidden" metastatic lesion of the lymph nodes of the central zone was found in 36.4%. Multifactorial analysis revealed predictors significantly increasing the risk of metastasis: age <55 years (p=0.008), extrathyroid invasion (p=0.016), male gender (p=0.017), tumor size >1 cm (p=0.026). CONCLUSIONS . An increased risk of "hidden" central lymph node metastatis in papillary thyroid cancer with cN0, was detected in patients younger than 55 years old, with the presence of extrathyroid invasion, males and tumors larger than 1 cm. These factors should be taken into account when choosing the amount of surgery.
Pheochromocytoma (paraganglioma) is a hormonally active tumor originating from the chromaffin tissue of the sympathoadrenal system, secreting a large amount of catecholamines. In the overwhelming majority of cases, this tumor is located in the adrenal glands; however, as early as 1953, I.J. Zimmerman et al. first described a clinical observation of a paraganglioma of the bladder. Since then, there have been publications in the global literature regarding the treatment of around 250 cases of this pathology. The diagnosis of bladder pheochromocytoma is often made late, even in the presence of the typical clinical symptoms described above. Early diagnosis of neuroendocrine tumors in atypical locations can be achieved by conducting tests for catecholamines, chromogranin A, and metanephrines in blood and urine. Given the rarity of this location, the complexity of diagnosis, preparation for surgery, and intraoperative challenges, this topic remains relevant. The removal of bladder pheochromocytoma can be performed through a transabdominal approach using modern endovideosurgical technologies, particularly the da Vinci robotic system, which ensures rapid resection of the bladder and minimizes the intraoperative hypertensive crises that may arise. This article presents a clinical case of bladder pheochromocytoma with robotic-assisted tumor removal. We present a case of urinary bladder pheochromocytoma with robot-assisted tumor resection.
The correlation between pheochromocytoma/paraganglioma (PHEO/PGL) and cyanotic congenital heart defects is rare but not coincidental. Research suggests that the development of PHEO/PGL in these patients maybe explained by chronic hypoxia, disruptions in the sympathetic nervous system, and potential genetic predisposition. These factors may provoke the tumor transformation of chromaffin cells. Additionally, diagnosing PHEO/PGL in patients with heart defects is complicated by hemodynamic disturbances that mask the characteristic sympathoadrenal crises of PHEO/PGL. The occurrence of these neoplasms can exacerbate the clinical course of congenital defects due to increased catecholamine secretion, leading to vasoconstriction and worsening hypoxia. We present two clinical cases of PHEO/PGL in the context of congenital heart defects, with patients observed and treated at the N.N. Blokhin National Medical Research Center of Oncology and the A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery. These observations emphasize the importance of vigilance for symptoms of tachycardia and uncontrolled hypertension in such patients. Despite their rarity, the relationship between these pathologies must be considered for accurate diagnosis and optimal treatment selection.
The article presents the results of a multicenter study of the treatment results of 35 patients with a preliminary clinical diagnosis of "adrenal cyst" who underwent various types of surgical operations or underwent non-surgical management. Radical operations were performed in 13 patients, puncture treatment in 22 patients. The incidence of tumors with cystic transformation among all patients with a preliminary clinical diagnosis of adrenal cyst was 15.4%, of which pheochromocytoma was 13.4%. Of the 13 operated patients, pheochromocytoma was detected in 23.1% of patients, in 76.9% benign tumors with cystic transformation and simple cysts were detected. BACKGROUND : Adrenal cysts are rare neoplasms of this localization. Among all tumors of the adrenal glands, cysts occur in 5–10%. Parasitic cysts due to echinococcal disease — up to 7%. Randomly identified cysts during X-ray examinations are observed in 5–9%. According to the results of autopsies, cysts amount to 0.06–0.18%. AIM : Evaluation and improvement of the results of differential diagnosis and treatment of patients with a preliminary clinical diagnosis of adrenal cyst. MATERIALS AND METHODS : The analysis of the results of examination, treatment and follow-up of 52 patients with a preliminary clinical diagnosis of "adrenal cyst" who were treated in six hospitals of the Moscow Department of Health from 2009 to 2023 was carried out. A retrospective analysis of CT images was performed in all radically operated patients and in 8 who underwent puncture treatment. CT criteria for simple cysts and tumors with cystic transformation are described, taking into account morphological results in radically operated patients. The long-term results of surgical treatment were evaluated in comparison with the results of observational (nonoperative) management tactics. RESULTS : Reliable CT criteria of a simple adrenal cyst have been identified, on the basis of which indications for surgical or non-surgical treatment of patients have been proposed. A comparison of the results of dynamic observation, sclerosis and radical surgery revealed that sclerosis is characterized by the highest frequency of complications (13.5%) and the lowest efficiency, and adrenalectomy / resection is characterized by a high frequency of "vain operations" — in 10 out of 13 cases (76.9%) in the absence of absolute indications for surgical treatment. The frequency of discrepancies in clinical and morphological diagnosis (cyst/tumor) was 8 out of 13 operated patients (61.5%, p-value <0.0001), and the frequency of critical discrepancy (cyst/pheochromocytoma) was 3 out of 13 operated (23.1%, p-value 0.044). At the same time, the reverse interpretation of the data obtained is of clinical importance: the decision on surgical treatment in this group of patients was correct in 23.1% of the operated patients — in the case of pheochromocytomas, whereas in the remaining 10 out of 13 cases (76.9%) there were no absolute indications for surgical treatment. CONCLUSION : Nonoperative management (dynamic follow-up) of patients with simple adrenal cysts is characterized by the best results in comparison with both types of surgical treatment.
In this case report the authors inform about primary hyperparathyroidism (PHPT) caused by an atypical tumor of the parathyroid gland. The diagnosis of PHPT was established only six years after the patient developed disease-specific complaints. According to scintigraphy with 99mTc-technetril and multislice computed tomography, a giant adenoma of the parathyroid gland on the right was identified. Considering the increased risk of the patient having a malignant neoplasm of the parathyroid gland, extended surgical treatment of PHPT was performed in the enblock volume. The operation was accompanied by resection of the right recurrent nerve. The reconstruction was performed with the formation of an epineural anastomosis with the medial portion of the fibers of the right vagus nerve, covering the suture line with a vascular coupling from a free graft of the branch of the saphenous jugular vein. Treatment allowed to achieve remission of the disease, but was complicated by the development of right-sided laryngeal paralysis. Vocal function was restored due to the achievement of the medial position of the right vocal fold and motor compensation of the left half of the larynx.
BACKGROUND: Hyponatremia is one of the most common and potentially dangerous complications following transnasal adenomectomy, making its timely detection and prevention critically important for improving treatment outcomes. Developing reliable models for predicting hyponatremia could reduce the risk of complications and enhance the quality of medical care for patients with pituitary adenomas. AIM: To analyze preoperative and postoperative parameters of patients to develop a prognostic model for hyponatremia development after transnasal adenomectomy. MATERIALS AND METHODS: A total of 122 patients were included in the analysis, of whom 38 (31%) were men. The patients were divided into two groups: those who developed hyponatremia by the 7th postoperative day and those who did not. The groups were comparable in terms of gender (p=0.425) and age (53 [34; 62] years vs. 44.5 [36; 56] years, p=0.172). A comparison of the groups was conducted across 42 parameters, including hormonal levels (ACTH, cortisol, TSH, free T4), the presence of cardiovascular diseases, carbohydrate metabolism disorders, and hypogonadism, the medication therapy administered, as well as tumor characteristics based on MRI data and surgical protocol details. RESULTS: No differences were found between the groups for any parameter (p>0.001). The groups were subsequently compared by laboratory parameters relative to reference ranges (TSH/ACTH/cortisol/free T4 above, below, or within the reference interval), tumor characteristics (e.g., color, consistency, position relative to the pituitary gland), and tumor morphology. No significant differences were identified for any of the parameters analyzed (all p>0.001). Thus, the groups with and without hyponatremia on the 7th postoperative day did not differ statistically, making it impossible to construct a prognostic mathematical model for this complication. CONCLUSION: The inability to predict postoperative hyponatremia based on preoperative parameters or surgical characteristics underscores the necessity of monitoring blood sodium levels until 10–14 days after transnasal adenomectomy.
BACKGROUND. Vocal cord paresis in 59% of cases is a result of surgical interventions on the organs of the neck and chest. However, thyroid surgery is the main cause of them (up to 49% of cases). Unfortunately, the most tragic complication — bilateral recurrent laryngeal nerve injury in 80% is associated with thyroidectomy. AIM. To determine the risk factors and causes of vocal cord paresis in patients after thyroid and parathyroid surgery. To analyze the clinical picture, catamnesis of postoperative vocal cord paresis. MATERIALS AND METHODS. The study included patients who underwent thyroid and parathyroid surgery. Laryngeal mobility was assessed in all patients before and after surgery (transcutaneous ultrasound, videolaryngoscopy). Surgical interventions were performed by 8 endocrine surgeons with mandatory visualization of the recurrent laryngeal nerve. In the late postoperative period videolaryngoscopy was performed in patients with vocal cord paresis every month. Patients monitoring was discontinued upon recovery of laryngeal mobility. RESULTS. In the study identified 2682 (100%) recurrent laryngeal nerves and diagnosed 169 (6.3%) unilateral vocal cord paresis. Preoperative vocal cord paresis (type A) was found in 0.5% of patients. Postoperative vocal cord paresis due to carcinoma invasion (type B) were noted in 0.5% of cases. Type “C” included inadvertent postoperative vocal cord paresis, occurring in 5.3% of cases. Factors such as sex, age, disease, chronic thyroiditis, increasing surgery, retrosternal location, and increased volume of the thyroid lobe did not elevate the level of postoperative vocal cord paresis (p>0.05). However, reoperation, progression of malignant processes and surgical technique influence the number of postoperative vocal cord paresis (p < 0.05). Vocal cord paresis was characterized by the following clinical properties: negative Valsalva test — 68.1%, choke on liquid — 46.0%, breathlessness — 7.4%, and the voice did not change in 24.5% of patients. Recovery of laryngeal mobility was observed in 67.2% of patients. In 97.1% of cases complete recovery of motor function was noted within the first 3 months after surgery. CONCLUSION. The clinical picture of vocal cord paresis in the early postoperative period ranging from asymptomatic forms to dysphagia and respiratory failure. Moreover, the symptoms and laryngoscopic findings are nonspecific (independent of the cause of recurrent laryngeal nerve injury), thus, not determining the prognosis for recovery of laryngeal mobility. However, in the long-term postoperative period indicators such as frequency of recovery, timing of recovery and volume of vocal cord mobility reflect three types of nerve damage — neurotmesis, neuropraxia, and axonotmesis.
BACKGROUND. Diabetic foot syndrome (DFS) significantly worsens the quality of life of patients, and is also a significant economic problem for healthcare. Understanding the clinical and laboratory characteristics of patients with DFS and type 1 diabetes mellitus (DM1) may be the key to prevention and timely detection of complications. PURPOSE. To study the clinical and laboratory characteristics of patients with DFS suffering from DM1. MATERIALS AND METHODS. A retrospective analysis of 759 case histories of patients with diabetes mellitus of the Limb Rescue Center at the V.P. Demikhov State Clinical Hospital in the period from 2019 to 2020 was carried out. The object of the study was a group of patients with DM1 (n=30). The statistical analysis was carried out using the STATISTICA 8.0 program. RESULTS. The average age of patients was 50.67±1.84 years (95% CI 46.89–54.44). 66.67% (n=20) of patients had a normal BMI, and the average BMI was 22.79±1.27 kg/m2 (95% CI 19.96–25.63). 86.7% had a long history of DM1. The median fasting plasma glucose was 13.1 mmol/l [7.1; 1.6]; and the average HbA1c was 8.71±0.26% (95% CI 8.18–9.25)). Almost half of the patients had microcytic anemia (47%, n=14). 66.67% (n=20) of patients already had a history of DFS. Hypertension was most common among the concomitant pathologies (50%, n=15) and atherosclerosis of the arteries of the lower extremities was almost as likely (46.67%, n=14). CHD (30%, n=9) and CKD (30%, n=9) were slightly less common among the studied patients as concomitant diseases. Only local treatment in the form of primary surgical treatment was provided mainly to patients with neuropatic form of DFS (46.67%, n=14). 10% (n=3) of patients underwent stenting, and 36.67% (n=11) underwent low amputation. The average duration of hospitalization was 11.55± 1.05 (95% CI 9.40–13.71) bed days. CONCLUSION. Analysis of clinical and laboratory data showed that patients with DM 1 hospitalized at the limb rescue center had significant risk factors for the development of ulcerative necrotic pathology: decompensation of carbohydrate metabolism, dyslipidemia, arterial hypertension. Understanding the importance of correcting risk factors can prevent patients from developing pathology requiring surgical treatment, including amputation, which can help reduce the duration of hospitalization and, consequently, reduce the burden on healthcare in economic terms.
RELEVANCE: thyroid surgery has always been particularly difficult. Today, surgeons are increasingly performing large-scale and complex hemi- and thyroidectomies. In cases of a malignant process, removal of the thyroid gland can be supplemented by central or lateral lymph dissection. Among the complications, damage to the recurrent laryngeal nerves occupies a special place due to its severity and potential to cause patient disability. The frequency of this complication, according to summary data, can reach up to 10%. OBJECTIVE: to develop a safe method for visualizing recurrent and non-recurrent laryngeal nerves during various thyroid surgeries. MATERIAL AND METHODS: the study analyzed treatment outcomes for 85 patients with various diseases of the thyroid gland treated at the Botkin hospital in 2024. Operations ranging from hemithyroidectomy to thyroidectomy with cervical lymphodissection were performed in the observed patients. During surgical treatment, microsurgical visualization of laryngeal nerves was performed using a method involving a virtual anatomical D-triangle to determine the search area in the paratracheal region. The D-triangle is defined as an isosceles obtuse triangle with its vertex at the laryngotracheal angle, formed by the lower border of the larynx, the lateral contour of the trachea (2 cm long), and the base connecting these lines. RESULTS: analysis showed that the required surgical outcomes were achieved in all cases without the development of laryngeal paresis or paralysis. Key findings include recurrent laryngeal nerves with normal and anomalous locations being identified. An embryonic anomaly of the right recurrent laryngeal nerve was noted in 1 (1.2%) case. Fascial fixation of the recurrent laryngeal nerve by thyroid capsule bundles was found in 4 (4.7%) cases. Extraorgan branches of the right recurrent laryngeal nerve were observed in 3 (3.5%) cases. One (1.2%) case involved a small-diameter lesion of the nerve. CONCLUSION: routine precision imaging of recurrent and non-recurrent laryngeal nerves using the proposed D-triangle method facilitates this challenging stage of thyroid surgery. The technique reduces the risk of laryngeal paresis and paralysis, ensuring safer outcomes for patients with various thyroid diseases.
BACKGROUND: When assessing the effectiveness of scar treatment, it is important to consider both the specialist’s assessment of the scar characteristics and the patient’s self-assessment of their condition. The Patient and Observer Scar Assessment Scale (POSAS) is a questionnaire recommended by international guidelines for evaluating the quality of scar formation, including after surgical treatment. AIM: To perform linguistic and cultural adaptation of the Russian version of the POSAS 3.0 questionnaire and to test it in the Russian patient population with various thyroid pathologies. MATERIALS AND METHODS: The linguistic and cultural adaptation of the POSAS 3.0 questionnaire was performed in accordance with modern international recommendations. It included the procedure of forward and back translations, testing of the Russian versions via patients’ interviews, expert evaluation of Russian version by specialists and decentering. RESULTS: The test version of the questionnaire was tested on 15 patients with various thyroid pathologies. Based on the interviews, an acceptable indicator of the external validity of the Russian version of the questionnaire was established. According to the survey of specialists (n = 9), its content validity was confirmed. CONCLUSION: The linguistic and cultural adaptation process resulted in the final Russian version of the POSAS 3.0 questionnaire, which is equivalent to the original version and corresponds to the ethno-linguistic characteristics of the population. The use of the POSAS 3.0 questionnaire in research and clinical practice is possible after assessment of psychometric properties of these tools.
