AIM To identify the multidetector computed tomography (MDCT) features of pancreatic neuroendocrine tumours (pNETs), which correlate with tumour histology and enable preoperative grading. MATERIALS AND METHODS Thirty-nine patients with histologically confirmed pNET who underwent preoperative contrast-enhanced MDCT were included in this study. Nineteen tumours were classified as Grade 1 (G1) and 20 as Grade 2 (G2). Histopathology slides were reviewed to assess the intratumoural microvascular density (MVD) and the amount of tumour stroma. Computed tomography (CT) image analysis included tumour size, margin delineation, calcifications, homogeneity, contrast enhancement (CE) pattern, tumour absolute and relative enhancement, presence of cystic changes, pancreatic duct dilatation, regional and distant metastases. The diagnostic ability to predict tumour grade was measured for each MDCT finding and their combinations. RESULTS The mean arterial enhancement ratio had a mean±standard deviation of 1.53±0.45 in G1 and 1.01±0.33 in G2 pNETs (p=0.0003) and correlated with intratumoural microvascular density (MVD; r=0.55, p=0.0002). Tissue stroma percentage did not correlate with imaging findings. Late CE of the tumour (the peak attenuation observed in the venous phase) was significantly associated with G2. Tumour size ≥20 mm, arterial enhancement ratio <1.1, and late CE showed 74.4%, 79.5%, and 74.4% accuracy, respectively, in diagnosing G2 tumours, while the accuracy of at least two of these criteria used in combination was 82%. Based on these results, a diagnostic algorithm was proposed, which showed high interobserver agreement (k=0.82) in the prediction of tumour grade. CONCLUSION Contrast-enhanced MDCT features correlate with histological findings and enable the differentiation between G1 and G2 pNETs during preoperative examination.

No abstract

Aim      Despite the regular heart damage in patients with coronavirus pneumonia caused by SARS-Cov-2, a possibility of developing lymphocytic myocarditis as a part of COVID-19 remains unsubstantiated. The aim of this study was to demonstrate a possibility of lymphocytic myocarditis and to study its morphological features in patients with the novel coronavirus infection (COVID-19) with a severe course.Material and methods   Postmortem data were studied for 5 elderly patients (74.8±4.4 years; 3 men and 2 women) with the novel coronavirus infection and bilateral, severe polysegmental pneumonia (stage 3–4 by computed tomography). COVID-19 was diagnosed based on the typical clinical presentation and positive polymerase chain reaction test in nasopharyngeal swabs. All patients were treated in different hospitals repurposed for the treatment of patients with COVID-19. A standard histological study was performed with hematoxylin and eosin, toluidine blue, and van Gieson staining. Serial paraffin slices were studied immunohistochemically with antibodies to CD3, СD68, CD20, perforin, and toll-like receptors (TLR) 4 and 9.Results In none of the cases, myocarditis was suspected clinically, added to the diagnosis or indicated as a possible cause of death. IHD and acute myocardial infarction were mentioned as error diagnoses not confirmed by the postmortem examination. The morphological examination of the heart identified signs of lymphocytic myocarditis consistent with Dallas criteria for this diagnosis. Myocardial infiltrate was characterized in detail, and a combined inflammatory damage of endocardium and pericardium was described. The immunohistochemical study with cell infiltrate typing confirmed the presence of CD3-positive Т lymphocytes and the increased expression of TLR-4. A picture of coronaritis, including that with microvascular thrombosis, was found in all cases.Conclusion      A possibility for development of lymphocytic viral myocarditis in COVID-19 was confirmed morphologically and immunohistochemically. Specific features of myocarditis in COVID-19 include the presence of coronaritis and a possible combination of myocarditis with lymphocytic endo- and pericarditis.

EVT provides thrombosis of FAs of celiac trunk and superior mesenteric artery branches in patients with chronic pancreatitis, as well as hemostasis for postoperative bleeding after pancreatectomy.

Хирургия поджелудочной железы весьма специфична. Бóльшая часть операций на этом органе требует специальных мануальных навыков, знания возможных вариантов сосудистой архитектоники и специфики патофизиологических реакций поджелудочной железы как на болезнь, поразившую орган, так и на операционную травму. Существует не много хирургических клиник, в которых радикально и успешно выполняют операции по поводу опухолей поджелудочной железы и хронического панкреатита. Институт хирургии им. А.В. Вишневского стоял у истоков отечественной хирургической панкреатологии. Благодаря инициативе руководителей института-академиков А.В. Вишневского, М.И. Кузина и

It was performed a retrospective analysis of the results of distal pancreatic resections (DPR) in 89 patients with different tumors. Conventional open operations were performed in 60 patients, robot-assisted - in 19 patients, laparoscopic - in 10 cases. Absolute indication for open surgery was pancreatic cancer T3-4 stages. Mini-invasive distal resections (robot-assisted and laparoscopic) were performed in cases of pancreatic cancer T1-2 stages, benign tumors and tumors with low potential of malignancy and diameter up to 4-5 cm. Results of robot-assisted and laparoscopic interventions are similar but robot-assisted technique provides more precise surgery. It improves quality of lymphadenectomy, decreases probability of intraoperative bleeding. Duration of robot-assisted and open operation did not differ significantly. Blood loss was significantly lower in group of robot-assisted method (mean 470 ml) while in cases of open and laparoscopic techniques this parameter was 1013.8 and 833.3 ml respectively. Postoperative complications in open, laparoscopic and robot-assisted groups developed in 45.1, 52.6 and 50% of observations respectively. Pancreatic fistulas were revealed in 58.8, 80 and 58.3% of cases respectively. There were not deaths after laparoscopic and robot-assisted pancreatic resections. 2 patients died after open surgery.

Цель исследования-представить опыт диагностики и хирургического лечения опухолей двенадцатиперстной кишки (ДПК). Материал и методы. В исследование включены 27 больных с различными опухолями ДПК: аденокарцинома (АК)-8, гастроинтестинальная стромальная опухоль (ГИСО)-13, нейроэндокринная опухоль (НЭО)-6. Из инструментальных методов диагностики применяли компьютерную томографию (выполнена 27 больным), магнитно-резонансную томографию (12), транскутанное ультразвуковое исследование (14), эндосонографию (16), эзофагогастродуоденоскопию (16). Все больные оперированы. Хирургические вмешательства осуществлялись традиционным доступом (18), лапароскопически (4), робот-ассистированно (4), эндоскопически эндолюминально (1). Оценка отдаленных результатов проведена 17 больным в сроки наблюдения от 8 мес до 10 лет (медиана 26 мес). Результаты. По данным инструментальных методов диагностики верифицировать опухоль ДПК удалось в 19 наблюдениях. При АК панкреатодуоденальная резекция (ПДР) выполнена 5 больным, паллиативные вмешательства (формирование обходных анастомозов)-2, эксплоративная лапаротомия-1. При ГИСО 3 больным выполнена ПДР, 10-резекция ДПК: лапаротомным доступом-4, лапароскопически-4, робот-ассистированы-2. При НЭО выполнено 3 вмешательства традиционным доступом: ПДР, резекция ДПК, энуклеация опухоли; 1-эндоскопическим эндолюминальным способом, 2 робот-ассистированные операции (резекция ДПК и дуоденумпанкреатэктомия, спленэктомия, дистальная резекция желудка). Послеоперационные осложнения возникли у 10 (37%) из 27 больных. Летальных исходов не было. Оценка отдаленных результатов лечения у 17 больных показала, что больные, оперированные по поводу ГИСО и НЭО, живы, прогрессирования заболевания нет. Из 4 больных с АК, о которых удалось получить информацию, живы 2. Заключение. Опухоли двенадцатиперстной кишки встречаются относительно редко. Радикальное хирургическое вмешательство, выполненное с соблюдением онкологических принципов, является методом выбора в лечении данной категории больных. В зависимости от морфологического варианта опухоли возможно выполнение органосберегающих вмешательств. Обследование и лечение больных с опухолями ДПК должно осуществляться в условиях специализированного хирургического стационара. Ключевые слова: двенадцатиперстная кишка, аденокарцинома, рак, гастроинтестинальная стромальная опухоль, нейроэндокринная опухоль, панкреатодуоденальная резекция, робот-ассистированные операции. ИНФОРМАЦИЯ ОБ АВТОРАХ Кригер Андрей Германович-д.м.н., профессор, заведующий отделением абдоминальной хирургии №1 ФГБУ «Национальный медицинский исследовательский центр хирургии им.

This method allows modeling of the main steps in robot-assisted intervention, optimizing operation of the manipulator and lowering the risk of injuries to internal organs.