Vol 22, No 4 (2017)

Osseous defects in the anterior wall of maxillary sinuses, which might appear as a result of maxillary sinusotomy, cause the retraction of soft tissues into the sinus with a follow-up adhesion to the posterior wall. This results in the obliteration of the sinus with scar tissue, formation of synechia, the obliteration of anastomosis and an increase in disease recurrences rate. We propose a new method of the plastic closure of the defect of the anterior wall of the maxillary sinus to restore the continuity of osseous walls of sinuses, which can be used in ORL clinics, oncological centers or dental clinics. For the first time a fragment made from polyether-polytetrafluorethylene threads was used. This implant has all necessary properties: it is durable, flexible and elastic; it is light and bioinert, it has no negative impact on the body; it is easily treated and is available for the use. We determined exact indications for the plastic closure of the defect of the anterior wall of the maxillary sinus. Using of the implant and the placing it on the muscle-periosteal graft protects it from the contact with the mucous lining of the maxillary sinus. The fixation of this implant not only to the underlying soft tissues but also to the overlying ones, creates a good frame, whereas preliminary sinus sanitation by ultrasound cavitation and layer-by-layer low-frequency ultrasonication of stitches allows slash risks of infecting the plastic material and surrounding soft tissues and, as a result, to reduce the number of recurrences of the disease in patients.

The aim of our research was to determine the possibilities to stratify patients with papillary thyroid cancer (PTC) on the group’s forecast, depending on the status of the mutation BRAF v600e and Ki-67 expression. The study included 89 PTC patients with the known prognosis for the period of 2005-2015. They were treated in the Altai regional oncology center and underwent surgery for PTC over the period of 2005-2013. Mutation p. Val600Glu (V600E) BRAF gene was determined with the use of allele-specific real-time PCR kit «Real-time-PCR-BRAF-V600E («BioLink»)». Immunohistochemical examination was performed with antibodies Ki-67 (clone MIB1, «DAKO») on stainer «Ventana XT» according to standard protocols. We revealed BRAF V600E not to be an independent predictor. Different variants of PTC, depending on the level of expression of Ki-67 in combination with a mutation of BRAF V600E was allowed to identify 3 groups of molecular types of PTC: a lack of mutation and a low Ki-67 (type I), with mutation and a low Ki-67 (type II) and with the presence and/or absence of a mutation and high level Ki-67 (type III). I molecular type PTC is the most favorable from the point of view of survival: 100% of patients live 10 years. Molecular type II is characterized by an intermediate prognosis: 76% of patients lived out up to 10 years. Molecular type III is characterized by the poor prognosis: only 36.8 percent of cases lived up to 10 years. In multivariate analysis of survival in PTC patients the independent prognostic factor happened to be the molecular type of tumor. In this case χ2 = 35 at p ≤ 0.000005.

Aim of the study. To estimate an influence of the Cavitron ultrasonic surgical aspirator (CUSA) on intraoperative blood loss. Material and methods. An analysis of 185 cases of extensive liver resections in patients for colorectal liver metastases has been performed. All patients were assigned to CUSA group (n = 56) or clamp crashing group (n = 129). Patients from the first group received regional FOLFOX6 or FOLFOX6 + bevacizumab chemotherapy. Preoperative chemotherapy did not performed for second group of patients. Results. Liver transection with CUSA did not lead to the decline in intraoperative blood loss (p = 0.35). Conclusion. Median intraoperative blood loss was 1065 and 1180 ml respectively. Method for liver transection did not lead to the decline in intraoperative blood loss (p = 0.35). Intraoperative blood loss increases from standard to extensive liver resection (p = 0.0007). Resection of contralateral blood lobe metastases did not lead to statistically significant increase in blood loss as compared with standard mode of the operation (p = 0.005).

To investigate protein content of ALK, Her2 and gene of Her2, CEP17 in interrelation with proliferative activity and survival in I-II stages lung adenocarcinoma cases. There were investigated 82 surgery samples taken from I-II stage lung adenocarcinoma patients. With the use of immunohistochemical method ALK protein (clone D5F3, Ventana), Her2 protein (clone 4B5, Ventana), topoizomerase IIα (clone JS5B4, Ventana), Ki-67 (clone MIB-1, Dako) were determined, Her2 gene was investigated with the use of the SISH method (Ventana) also. The positive expression of ALK is detected in 4(5%) cases, Her2 - in 16(20%) cases and amplification of Her2 gene - in 7(9%) cases. In lung adenocarcinoma with positive expression of ALK protein and amplification of Her2 gene low proliferative activity was noted (on labeling index Ki-67 and topoizomerase IIα). The survival of lung adenocarcinoma patients was less in cases of a positive expression of ALK protein in comparison with patients with the negative expression (difference is not reliable). Statistically significant low survival rates of patients is found in cases with amplification of Her2 gene. According to data mono- and multifactor regression analysis the amplification of Her2 gene has been interrelated with the poor forecast. Mutation of ALK gene and amplification of Her2 gene are interrelated with the proliferative activity and survival rate of lung adenocarcinoma patients.

The problem of queues in polyclinics and hospitals is a deterrent to ensuring access to oncological care. In order to optimize anti-cancer control there were shortened timelines both for the diagnosis and the beginning of the specific treatment. Since 2012, in the Tomsk Regional Oncology Center a new concept of the polyclinic organization on the profile of «oncology» was formed. The key aspects of this concept were: 1) standardization of the medical staff work; 2) the rules for the routing of patients with the execution of the first medical appointment booking for visiting doctor through the registry, for the second visit - by an oncologist and with the differentiation of the streams of patients for medical care in the framework of MHI and medical services on a fee basis; 3) intensification of the provision with outpatient specialized care with the staff reinforcement: the regime of the polyclinic is organized in two shifts and 6 days a week, the number of doctors and nurses is increased by 60.8%, the number of medical registrars - by 7 times. To coordinate their work, the position of the senior medical registrator was introduced; 4) modernization of all workplaces of doctors, nurses, medical registrars with the provision of modern medical equipment, communications and information support; 5) logistics of the registry: the division of its zone into a «front office» - were the office-medical registrator communicates with patients only as «face-to-face» and «call center» - with a dialogue by phone. 6) quality control of the clinic work with evaluation of video and audio recordings of interaction between registrars and patients, visitors questioning. 7) the reform of the oncological consultation on an ongoing basis regulations; 8) increasing the comfort of waiting for patients with the organization of comfortable seats, coolers with glasses, air conditioners, corporate identity and logo. The result of the implemented activities was a reduction in the start of specialized treatment by 68.3%, increased coverage of antitumor therapy by 16.4%, including among rural residents. This contributed to the improvement of the situation in a number of indices: the increase in the share of early forms of malignant neoplasms, active detectability by 21.6% and 164.7%, respectively, a decrease in one-year mortality rate, neglect by 25.2% and 8.6%, respectively. Population satisfaction with the provision of cancer care increased.

The relevance of the study of lung cancer is associated with a high incidence and mortality rate. The article is devoted to the study of indices of the prevalence rate of the lung cancer in the Altai Territory for the period of from 2014 to 2016. An increase in the prevalence rate of lung cancer has been established to be of 61.4% (2016) per 100 00 population (both genders), the increase in the «rough index» accounted for 7.4%. With the bearing in mind the age-gender characteristics, statistical analysis showed the highest level of the prevalence rate of cancer of the trachea, bronchus and lung to be observed in males, that amounts of 19.3% among malignant tumors detected in 2016 in the Altai Territory. The greatest increase in the incidence rate of lung cancer is observed in both males and females in the age group of 60-69 years. In stage I-II lung cancer patients there is noted the gain of the specific weight and the decline in the mortality rate to 40.3 per 100 000 population of the Altai Krai.