Background. Parathyroidectomy is the only effective method to improve the clinical and laboratory manifestations of the primary hyperparathyroidism (PHPT) and reduce the risk of urinary calculi formation. However, there are controversies about the existence of renal form of PHPT and about the effectiveness of surgery with regard to the risk of stone formation. Aims. To evaluate the effectiveness of PHPT surgical treatment in relation to clinical, laboratory parameters, as well as the risk of stone formation. Materials and methods. In a prospective single-arm observation one-center nonrandomized study we included patients with PHPT in whom parathyroidectomy was performed in 2012–2015. We analyzed clinical and laboratory parameters before and after surgery in a period from 1 to 3 years. Results. The study included 105 patients, of whom 35 (33.3%) had urolithiasis. Blood calcium after the surgery decreased from 2.72 mmol/l [2,56; 2,97] to 2,3 mmol/l [2,2; 2,35], p < 0.001. Blood calcium concentration decreased to normal values in all patients. Parathyroid hormone level decreased from 206 pg/ml [123; 347] to 72,8 pg/ml [30; 113], p < 0.001. Clinical symptoms questionnaire estmation decreased from 4 points [3; 6] to 2 points [1; 4], p < 0.001. In patients with urolithiasis clinical symptoms before treatment were more pronounced – 5 points [3; 7] vs. 4 points [3; 5] (p = 0.015) and decreased more significantly – by 3 points [2; 4] vs 2 points [1; 3]. The daily calcium urine excretion decreased from 11.4 mmol/day [8.9; 13.9] to 5.4 mmol/day [4.1; 6.8], p < 0.001. In 2 cases (5.7%; CI, 0.7–19.2%) we observed the progression of urolithiasis after surgery. The age of patients correlated with daily calcium urine excretion after surgery (r = 0.69; p = 0.028). Conclusions. Parathyroidectomy normalizes blood calcium and parathyroid hormone, improves clinical symptoms and reduces the risk of stone formation.

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Приведено уникальное наблюдение нетипичной множественной эндокринной неоплазии 1-го типа (МЭН-1) (смешанный вариант) у мужчины 48 лет, обусловленной наличием у него 9 опухолей и множественных гиперплазий в 8 различных органах (околощитовидных железах, поджелудочной (ПЖ) и щитовидной (ЩЖ) железах, в двенадцатиперстной кишке, легком, желудке, коже, надпочечниках). Особенностью данного случая является медуллярная карцинома ЩЖ, которая обычно ассоциируется с синдромом МЭН-2. У пациента имела место типичная клиника гипогликемического синдрома, однако среди всех исследованных нейроэндокринных опухолей инсулин-продуцирующих клеток не оказалось, что не исключает наличия невыявленной (возможно, очень маленькой) опухоли ПЖ. В то же время известно, что клинические проявления МЭН-1 могут быть обусловлены суммарным эффектом всего комплекса гормонов, продуцируемых одновременно несколькими множественными опухолями.

Aim. To carry out the comparative analysis of the results of ambulatory treatment of patients with chronic hemorrhoid using “Step-by-Step” technology and surgeries in hospital conditions. Materials and methods. The results of treatment were analyzed in 4 representative groups: 31 patients of the main group underwent a staged “Step-by-Step” hemorrhoidectomy in ambulatory conditions, 29 patients of the first group of comparison – Longo operation, 32 patients of the second group of comparison – laser hemorrhoidectomy, 29 patients of the third group of comparison – Milligan-Morgan operation. Results. In the main group, the rate of complications was noted in 1.4 %, after Longo operation – 9.8 %, after laser hemorrhoidectomy – 6.6 %, after Milligan-Morgan – 11.2 %. Relapse of disease was registered in 0.6 % of patients of the main group, 6.1 % – first group of comparison, 3.8 % – second group and 3.5 % – third groups. Conclusions. The best treatment results were obtained in patients after using the technology “Step-by-Step” at the expense of a minimum rate of complications and less number of relapses that permits to recommend this technique for a wide clinical application.