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In recent years, predictive methods for assessing the preservation of the parathyroid glands have been actively implemented. The article describes the first experience of evaluating the blood supply of the parathyroid glands by quantitative determination of the indocyanine green (ICG) accumulation index in real time in 6 patients before and after a thyroidectomy with central neck lymph node dissection for papillary thyroid cancer. Intraoperative fluorescent angiography was performed by using domestic equipment with a fluorescent module, as well as by using a domestic medication of ICG. Intraoperative values of the ICG accumulation index were compared with the levels of ionized calcium and parathyroid hormone perioperatively. No clinical manifestations of hypocalcemia were detected in the postoperative period. The obtained results showed the informativeness of the numerical assessment of the intensity of ICG fluorescence. The evaluation of the distribution (accumulation) of ICG has prospects for practical application in thyroid surgery in the formation of tactics for preserving the parathyroid glands and predicting postoperative hypoparathyreosis.

Chyloptysis is a rare disease characterized by formation of bronchial casts containing chyle and repeating bronchial tree branching. The authors report a 56-year-old woman with chyloptysis accompanied by cough and expectoration of milky bronchial casts, as well several episodes of asphyxia. Stages of diagnosis and successful treatment including thoracic duct ligation and skeletonization of the root of the left lung are described. The authors also analyze literature data on etiology, pathogenesis and feasibility of conservative and surgical treatment of these patients.

Aim: To estimate immediate and remote resaults of treatment of adrenocortical cancer with invasion into great veins., Material and Methods: It was analyzed survey and treatment results in 3 patients with adrenocortical cancer and invasion into renal veins and inferior vena cava., Results: Radical surgery with tumoral thrombi removal from great vessels was performed in all cases. There were no complications and deaths in early postoperative period. Life expectancy after surgery was 6, 13 and over 58 months., Conclusion: At present time surgical intervention for adrenocortical cancer with invasion into great veins is single method to prolong patients' life.

Primary hyperparathyroidism is the most common disease in Russian Federation, cured by endocrine surgeons. Health status after surgical correction of primary hyperparathyroidism depends on availability of screening hypercalciemia, which is still absent in our country. Another problem is a model of surgical management of primary hyperparathyroidism (frozen section, intraoperative monitoring of parathyroid hormone, gamma-detection and so on). Although minimally invasive parathyroidectomy has become the only method of treatment in many countries, it is still crucial to identify and accurately localize parathyroid glands before bilateral neck exploration surgery. The diagnostic efficacy of the various imaging techniques is still the subject of current debate. The usefulness of preoperative parathyroid imaging with both dual scintigraphy-single-photon emission computed tomography (SPECT) Tc 99m and high-resolution ultrasonography (US) was studied in 92 patients undergoing operations for primary hyperparathyroidism. The accuracy of "integrated" ultrasonography ("check-up US", "target US" after SPECT) and "intraoperative US") of parathyroid glands was 92.9%, sensitivity - 91% and positive predictive value - 94%. This study supports an algorithm of obtaining "integrated" ultrasonography as the initial and in most cases the only preoperative localization tests for patients with primary hyperparathyroidism.

Experienced multivalent surgeons are well aware that any operation has its own Achilles heel. In surgery for cholelithiasis, this is a risk of damage to the bile duct, in surgery for varicose veins - the femoral vein, in surgery for the colon and rectum - the ureter, in cardiac surgery - the ascending aorta, and in surgery for the thyroid gland - the recurrent laryngeal nerve.

Own and foreign experience in surgical treatment of thyroid gland (TG) diseases was analyzed. Surgical anatomy of TG, effective methods of surgical techniques, classification of disorders of vocal cords mobility, and treatment policy are described. It is demonstrated that no less than 70-80% patients with respiratory disorders after surgeries on TG can avoid tracheostomy and subsequent complex and sometimes staged plastic surgeries on the larynx. Proposed recommendations permit one to reduce risk of postoperative complications, to improve long-term results of surgical treatment and life quality of operated patients.

Different methods of diagnosis and treatment of thyroid gland's adenomas are analyzed. Current surgical treatment of euthyroid goiter is reviewed. Basing on long-term studies, the role and place of special diagnostic methods (ultrasonic scanning and fine needle biopsy) and indications for their use and surgical treatment were determined. The proposed treatment and diagnostic algorithm reduces the number of unjustified surgeries. When elective histological examination reveals thyroid cancer, reoperation is not necessary. The groups of patients with confirmed diagnosis "thyroid adenoma" and high cancer risk were distinguished. Optimization of differential diagnosis of thyroid adenoma and cancer based on cytological and immunogenotypic tests will help determine indications to surgical treatment in adequate scope.