Vol 20, No 5 (2015)

Applying modern methodological approaches to inspection, it is not always possible to establish the nature of the spherical formation of lungs (SFL). The way of assessment of internal structure SFL consisting of target volume densitometry, allowed to receive consecutive selections in the allocated zones of interest of values of pixels from files in the DICOM format, to carry out the analysis of distribution of densitometrical density, both to the cut planes, and taking into account various cuts in the allocated volume. The newly developed technology of the densitometrical analysis of spherical formations of lungs on the basis of neural networks, is capable to classify the numerical data obtained from computer tomograms by means of the software «Radiologist +». Sensitivity at division of «primary cancer - infiltrative tuberculosis» made 91.1%, specificity - 88.6%, accuracy - 90.2%. Sensitivity at division of «primary cancer - pneumonia» made 90.4%, specificity - 74.5%, accuracy - 84.2%. Sensitivity at division of «infiltrative tuberculosis - pneumonia» made 79.5%, specificity - 80.8%, accuracy - 80.2%.

A complex examination of 122 patients with II and III stages of neoplasms were carried out for the purpose of definition of results of correction of disturbances of endothelial functions in operated patients with gastric cancer. All patients were exposed to radical surgical treatment. Endothelium function indicators and contents of circulating endothelial cells were studied. It is revealed that application of L-arginine and ACE inhibitor provides decrease in degree of endothelial dysfunction and damages an endothelium that correlates with decrease in frequency of postoperative complications, late complications in the form of development of recurrence and metastasises and mortality.

Clinical case. In the Institute of Pediatric Oncology and Hematology a 3-year-old boy underwent comprehensive examination, including modern methods of radiological diagnostics and morphological studies. The diagnosis was proved as multiple synchronous primary tumor: 1) Miksofibrosarkoma of soft tissue of the anterior chest wall, stage I. T1N0M0. 2) Neuroblastoma of the pelvis, stage I by INSS. We performed radical surgical treatment. According to the protocols of treatment we performed all necessary additional studies to identify risk group for each tumor. The tumors showed low risk. The patient needed no special treatment. Results. Following the postoperative period the child is being under dynamic monitoring. At present the patient is alive without evidence of recurrence or disease progression. Conclusions. Morphological verification of diagnosis at the initial stage of treatment is important for determining treatment strategy. Current approaches to the definition of risk for cancer can achieve good results without undue intensification of treatment.

This arcticle presents possibilities of combined treatment of a patient with advanced gastric cancer. The patient with gastric cancer and hepatic, paragastric and left supraclavicular metastases was treated by chemotherapy. 8 courses of chemotherapy by docetaxel + cisplatin + 5-fluorouracil + leucovorin resulted in complete regression of distant metastases. This allowed conducting D2 subtotal gastric resection in the patient. Morphologic examination of the tissue samples obtained during surgery identified a low-differetiated gastric adenocarcinoma infiltrating gastric wall to the subserous layer. No metastases were detected in locoregional lymph nodes. Adjuvant chemotherapy was discontinued after 2 courses because of increasing neuropathy. Over the follow up period no disease progression has been registered by April 2015. The overall survival reached 67 months. Thus, combined treatment of the patient resulted in increased overall survival.

Studying of large microspheres (MS) from polyvinyl alcohol with the diameter of (d) of 0.2-0.6 mm in the infusional volume of 0.4-0.9 ml is directed for detection of their features necessary for preclinical study with surgical access to a femoral artery. Two problems were solved: development of trans-arterial (t.a.) technique introductions to rats and efficiency assessment t.a. embolization on rabbits. Experiments on the rats under general anesthesia are made with d=0.2-0.3 mm of MS. For preclinical study of the technique on rats with the body weight of 120-150 g, infusional system with catheter of G26 and period of observation within 7 days allowing to control efficiency of embolization of tumor intertwined in the blood supply zone is recommended. Experiments on rabbits under general anesthesia are made with MS diameter of 0.4-0.6 mm of MS. By means of X-ray contrast visualization decrease in intensity of a regional blood-stream is shown expressed up to full and long (not less than 14 days) for all of the volumes of MS. The best results of embolization are received with G20 catheter in infusion system. Local trophic changes under the influence of MS (side effects) are regarded as modeling artifact on rabbits connected with full switch off of blood-groove in rather small vessel and violation of innervation of the extremity. The analysis of the revealed features with selection of adequate characteristics of the ISS and tools reached efficiency and complications of trans-arterial embolization allows to recommend the fulfilled technique on rats for preclinical study of large ISS from polyvinyl alcohol, and to consider LMS perspective for trans-arterial embolization or chemoembolization of tumor.

The article summarizes five years of experience teaching doctors of various specialties for implantation of venous port systems in children with cancer. Material and methods. In 2010-2014 we conducted a training technique of implantation of venous port systems for 65 doctors. Of these, 27 (41.5%) were trained in the courses of the International School of Postgraduate Education “Aesculap-Academy”, and 38 (58.5%) - at the Department of Pediatric Oncology GBOU DPO RMAPO the Ministry of Health. The training was conducted at the institute of Pediatric Oncology and Hematology. Results. The total number of students who have mastered the technique of 13 people (48.1%) of which 9 (69.2%) Anaesthetist and 4 (30.7%) of pediatric surgery. However, only 3 (23%) with certificates doctor - Anaesthetist, mastered one conducting courses implantation technique using ECG monitoring. From mastered the technique of only 3 people (2 Anaesthetist and 1 Surgeon) expressed confidence that will be able to be implanted venous port system in the presence of an experienced assistant. Conclusion. It is necessary to upgrade the training of doctors at the level of postgraduate education and reform program training courses for working professionals.