No abstract

Вве де ние Нейроэндокринные опухоли (НЭО) поджелудочной железы (ПЖ) выявляют редко, в 1 наблюдении на 100 тыс. населения [1, 2]. Однако работы зарубежных авторов свидетельствуют об увеличении частоты заболевания за последние два десятилетия, что во многом обусловлено совер шенствованием методов диагностики. По данным ряда исследователей, частота НЭО ПЖ в сериях аутопсий составляет 2-10% [3, 4]. За последние 20 лет значительно возрос интерес врачей многих специальностей, а также пациентов к этой проблеме, что выразилось в создании врачебных сообществ, занимающихся диагно

Insulinoma is the most common pancreatic neuroendocrine tumor. Surgical management of insulinomas is considered to be the only curative method. However pancreatic surgery is associated with postoperative complications. The most difficult category of patients is patients previously operated on the pancreas. The aim is to show our experience of treatment patients with reoperated insulinomas. Materials and methods. 201 patients were operated because of insulinoma in the abdominal surgery department of Sechenov University from 1993 to 2019. 18 patients of them were reoperated. The authors describe their treatment experience of this category of patients. Results. The rate of reoperations in pancreatic insulinomas was 9%. Most of the tumors (12 of 18) were located in the head. Six patients were reoperated due to newly developed insulinomas. 12 patients were previously operated in other clinics but the tumors were not detected. This group of patients were the most complicated in imaging so we had to apply selective intra-arterial calcium stimulation test. All reoperated patients developed destructive pancreatitis in the postoperative period, five patients developed pancreatic fistula of classes B and C, two patients died. Conclusion. Accurate preoperative imaging carried out by an experienced team in reference center is an important factor for reducing the level of postoperative complications. Patients who had pancreatic surgery before should be treated by experienced multidisciplinary team.

Recent epidemiological studies have demonstrated that the development of a potentially reversible moderate acute kidney injury is associated with worsening clinical outcomes and an increased risk of death. This is especially true for patients with plural comorbidities who require procedures with IV radiopaque agents. This paper presents a clinical case of an elderly patient who requires coronary angiography, and who has common clinical conditions such as hypertension, multifocal atherosclerosis with the development of renal artery disease and the presence of a history of acute cerebrovascular accident and myocardial infarction, and chronic heart failure as well. Particular attention is given to assessing the risk of developing contrast-induced acute kidney injury in patients with cardiovascular disease, as well as discussing current views on the possibility of prescribing drugs that affect the reninangiotensin system in cardiac patients with concomitant renal artery disease.

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