BACKGROUND: One of the most important tasks in thyroid surgery is to prevent the development of specific complications — laryngeal nerve dysfunction and hypoparathyroidism. A significant number of technical solutions introduced into clinical practice in recent years are aimed at solving this problem.

AIM: Тo evaluate the results of an alternative technique of thyroid surgery — medial thyroidectomy.

MATERIALS AND METHODS: 270 patients with thyroid diseases were operated on using tension free thyroidectomy technique in the volume of hemi- or thyroidectomy with or without cervical lymphadenectomy. The selection of patients was continuous. All patients underwent ultrasound or videolaryngoscopy before the operation and on the 1st postoperative day. Patients who underwent thyroidectomy underwent blood analysis for parathormone and blood analysis for ionized calcium.

RESULTS: For hemithyroidectomy the duration of surgery did not change. In the group of patients with nodes up to 30 mm the duration of surgery increased. An increase in the operation time was also noted for thyroidectomy. Unilateral laryngeal paresis was registered in 6 (2.3%) patients or 1.7% of the number of recurrent laryngeal nerves in the risk area. The risk of parathyroid gland (PTG) removal was 0.39% of the number of operations and 0.14% of the number of PTG in the risk area. Decrease in the level of parathormone in the first day after surgery was noted in 11.5% of patients. The development of postoperative hematoma was noted in 1 patient (0.39%).

CONCLUSION: The technique of thyroid surgery with medial access to the recurrent laryngeal nerve and parathyroid glands is feasible in the vast majority of patients with thyroid diseases requiring surgical treatment and shows high safety and a number of advantages over the traditional method of thyroid surgery.

BACKGROUND: To date, surgical treatment is an effective treatment of hypercortisolism in primary bilateral macronodular hyperplasia (PBMAH). Due to the bilateral lesion, the most common treatment in Russia is the bilateral adrenalectomy, which requires the appointment of hormone replacement therapy. The results of various studies on the effectiveness of unilateral adrenalectomy (UA) in PBMAH are rather discordant.

AIM: The objective of the study was to assess the outcomes of UA in patients with PBMAH, accompanied by mild autonomous cortisol excess (MACE) or overt Cushing’s syndrome (CS).

MATERIALS AND METHODS: 44 patients with PBMAH and a manifest form of CS (n=21) MACE with comorbid conditions (n=23) underwent UA in the surgical department of the Endocrinology Research Centre. The dynamics of laboratory parameters (cortisol after overnight dexamethasone suppression test (cortisol ONDST) urinary free cortisol (СКМ), ACTH), as well as the course of comorbid diseases (diabetes mellitus, arterial hypertension (AH), metabolic disorders) were assessed before and after 6 months of surgical intervention. The cut-off level of blood cortisol (8:00–9:00) during the first day after OA was determined as a predictor of the development of adrenal insufficiency (AI) in the early postoperative period.

RESULTS: 6 months after OA, laboratory parameters improved in 40/44 (91%, 95% CI: 78%-97%) cases: cortisol ONDST decreased from 466 [173; 652] to 86 [61; 149] nmol/l, p=<0.01, СКМ dropped from 840 [468; 1892] to 267 [204; 432] nmol/day, p=<0.01), while ACTH increased gradually from 1 [1; 2.1] to 8.3 [2.6; 15.0] pg/ml, p=<0.01), which indicates the effectiveness of UA. Statistically significant changes in BMI were also obtained (before UA — 30.8 [27.5; 34.4], after — 28.5 [23.9; 32.2] kg/m² (p <0.01)). When analyzing the long-term outcomes of UA on carbohydrate metabolism, a decrease in the level of HbA_1c from 7.0 [6.3; 7.7] to 6.0 [5.6; 6.7] %, (p<0.01) was observed. Further, there was an improvement in the course of AH. After UA, antihypertensive therapy was completely discontinued in 27.7% of cases, and a reduction in the number of antihypertensive drugs was carried out in 44.4%. The level of cortisol in the early postoperative period less than 325 nmol/l was the strongest factor predicting the potential adrenal failure (AUC=0.96).

CONCLUSION: UA can be recommended as the first line treatment of PBMAH with CS due to the high probability of longterm remission of hypercortisolism and improvement in the course of comorbid diseases.

BACKGROUND: Obesity is associated with development of menstrual disorders (MD), a decrease in ovarian reserve and infertility. Treatment of obesity contributes to the normalization of the reproductive function of women. Bariatric surgery is known to be the most effective method of obesity treatment, while the most common intervention is the sleeve gastrectomy (SG), the effect of which on menstrual function and ovarian reserve has not been studied enough.

AIM: To study the effect of SG on menstrual function and ovarian reserve in obese women of reproductive age

MATERIALS AND METHODS: Female patients with BMI ≥ 35 kg/m2 aged 25 to 36 years were examined. At baseline and 6 months after SG, the characteristics of menstrual function were determined, BMI and HOMA-IR were calculated, and the level of anti-Müllerian hormone (AMH) was measured. The obtained parameters were compared in patients with and without MD

RESULTS: . In all patients, 6 months after SG, there was a decrease in BMI: 30.1 kg/m2 (29.3–32.1) and 39.3 kg/m2 (37.3–41.0) (p<0.001), HOMA -IR: 5.0 (4.1–5.9) and 2.8 (2.1–3.2) (p=0.001). The initial level of AMH in patients with MD (n=12) was lower than in patients with normal menstrual function (n=10): 2.4 ng/ml (1.9–2.0) and 3.2 ng/ml (2.6–4.2), respectively (p=0.032). A significant increase in AMH levels occurred only in the group of patients with MD (p=0.04). MD remained only in 3 women.

CONCLUSION: SG in patients of reproductive age with obesity is associated with the normalization of menstrual function and an increase in AMH, as well as a decrease in the degree of insulin resistance.

The availability of modern high-precision diagnostic methods increased the detection rate of pancreatic neuroendocrine neoplasia (pNEN). There is no doubt concerning the necessity of surgical treatment for localized functioning tumors, whilecurrently there is no objective way to choose the tactic for non-functioning asymptomatic neuroendocrine tumors of the pancreas (pNET) with the exception of the tumor size.

Treatment tactics for non-functioning asymptomatic T1 neuroendocrine tumors (less 2 cm in size) are debatable. According to literature surgical treatment for lesions less than 2 cm does not always increase survival. In the same time even in high-volume centers pancreatic surgery shows high morbidity and mortality rate. Prospective randomized trials comparing surveillance and operative treatment are not published yet, as far as authors concerned. International guidelines answer the question of treatment such neoplasms ambiguously, while national Russian recommendations do not cover the topic. Guidelines are based on heterogeneous retrospective studies; therefore, the aim of scientific research is to determine reliable criteria for patient selection for dynamic observation or surgical treatment.

This article provides an overview of 60 scientific publications covering the problem.

The article tells about the work and scientific achievements of Professor K.I. Myshkin — surgeon, founder of the school of endocrine surgery, teacher, whose example has become a guide for many on their professional path. Materials about the  biography of the great professional, information about the continuation of his scientific achievements by his students and followers are given.