EDITORIALS
Materials to the report of the Deputy of Rector on Medical work of the Vladivostok State Medical University devoted to the hospital bases of high school. The data on introduction of new methods of diagnostics and treatment are shown, the structure of complications and death rates is analyzed, prospective of development of public health services of region are outlined.
LECTURES
The structure of the oncological facilities of Far Eastern region is characterized by significant deterioration (from 51 up to 100%) of the diagnostic and radiological equipment, differentiation of levels of balance cost of the equipment (from 15.8 up to 293.25 million rubles). The funds parameter changes from 104714 rubles in Oncological clinic of Magadan up to 1001100 rubles in a clinic of Khabarovsk. The general sign is the high parameter of deterioration of the diagnostic and radiological equipment – from 51% in the clinic in Amur area up to 100% in the clinic of the Kamchatka area.
REVIEWS
The review of the literature devoted to morphology and pathogenesis of epilepsy. Despite of the big variety of ethio-pathogenetic factors of this disease and the various neural networks, pathogenetic processes have some similar moments which concern laws of formation of the centers of damage and neuron devastation. These components in hippocampus formation include nitroxide-ergic cage neurons and glutamate-ergic pyramid cells, parvalbumin- and calbindin-containing interneurons of the hippocampus and calretinin neurons of the gate of fascia serrata. In neo-cortex these are parvalbumin cage cells and cells – candelabrums, calbindin gliacytes and cells of CajalRetzius, and also astrocytes and vessels in their nearest microenvironment.
ORIGINAL RESEARCHES
The results of research of the level of circulating immune complexes and C3-C5 complement components at onco-gynecologic patients are resulted. Decrease in the level of complement components and increase of the level of immune complexes that testifies the depression of antineoplastic mechanisms of protection is found. After the treatment, including surgical, using tinrostim, and also at using of this medication in a complex of preoperative treatment, the level of circulating immune complexes in blood was reduced, and the level of complement components raised.
In this work the hysteroscopic results and also cytological and morphological analysis of endometrial aspirates in at 20 girls – teenagers (12–17 years) with ovarian tumors and masses are shown. In 2/3 of cases the uterine pathology is revealed. It is concluded, that the analysis of endometrium allows to choose rational tactics of treatment with the purpose of preservation of reproductive function at this category of patients.
The average level of some onco-markers and frequency of registration of cases with excess of their norm at workers of Joint-Stock Company LuTEK (Pozharsky area of Primorsky Region) is analyzed. It is shown, that at the persons occupied in electric power production the concentration of the cancer-embryonic antigen, the ovarian cancer antigen and prostate- specific antigen is raised with increase of the experience of work. Distinctions on departments of the enterprise are revealed. It is judged the necessity of monitoring of the onco-markers for duly early diagnostics of tumors at people occupied on harmful work.
The retrospective analysis of 267 combined surgeries concerning stomach cancer is done. The volume of intervention extended due to removal and a resection of the other organs involved in tumor’s process (esophagus, spleen, lymph nodes, liver, pancreas, etc.). The parameters of 3-and 5-years survival rate were 29.4±3.1 and 17.6±2.7% accordingly. It is judged the expansion of indications to the combined interventions at stomach cancer.
Total 80 women suffering by onco-gynecologic diseases are examined. Part of the patients in a complex of pre- and postoperative therapy have been added the biologically active additive ”Tinrostim“. In dynamics of the postoperative period the patients with not purulent complications still had the ability to cytokine production; at severe purulent complications this ability was reduced. The use of ”Tinrostim“ at a stage of preoperative care resulted in moderate increase in the level of the tumors necrosis factor -α, IL-4 and γ- interferon in blood in the postoperative period. The use of ”Tinrostim“ in a complex of postoperative treatment was accompanied by increase of cytokine production only in case of not severe complications.
The retrospective analysis of 111 cases of a breast cancer. The estimation of value of various diagnostic methods is done. It is marked, that sensitivity of ultrasonography was 88.3%, and specificity – 96.8%. Sensitivity of complex diagnostics a combination of ultrasonography, mammography and needle-biopsy was up to 100%, and specificity 95.5%.
1110 cases of prostate diseases are analyzed: benign hyperplasia, intra-epithelial neoplasia and cancer. It is shown, that underestimation of prevalence of prostate cancer results in casual revealing of the disease at trans-urethral resection and trans-bladder adenomectomy, that complicates the further radical treatment of patients. One of the basic methods of treatment of the located prostate cancer is radical prostatectomy. This type of surgery with the use of ultrasonic cavitator allows to reduce the frequency of surgical complications by 15.7%.
Patients of municipal polyclinics who are potential oncological patients in 64.3±2.2% of cases had the personal income below a living level. About 75.0±1.2% of oncological patients in Primorsky Region are also people with the personal income lower than a living level. The poverty of the population as by-product of the reforms and also the long psycho-emotional and social stress is the important social – hygienic risk factors of oncological diseases.
Chonic alcohol intoxication and one reception of alcohol have been moduled on 30 male-rats. Nasal mucosa of rat has been examined with the help of toluidune blue. Mast cell have been found out to be regulation of local homeostasis and react to one or multireception of alcohol by changing the number of cell, value of profile field and coefficient of degranulation. The correlative connection has been found out between these changes.
38 cases of stenting by plastic stents of diameter 11.5, 10.0 and 8.5 Fr at patients with malignant pancreato-duodenal tumors are described. Stents have been successfully used in 81.5% of cases. Stents of diameter 11.5 and 10.0 Fr were passable not less than 3 months, stents of 8.5 Fr – till 2 months.
We analysed 100 cases of the central hemodynamics in patients with different stages of lymphomas treated by usual schedules of chemotherapy and high-dose schedules with high dose of the cytostatics. Our group was consist of the patients with the different histological types of this disease. They were separated in 3 groups and each of it were underwent full reological investigation of the central, lung and liver hemodynamics. Those patients who achieved completed remission and had no poor prognosis factors had significant advances in haemodynamics restore than others.
The analysis of results of work of Colo-proctology University Department for 10 years (1995-2004). Growth of the morbidity of rectal (1501 case) and colonic cancer (839 cases) in the population is emphasized; the modern surgical tactics and tactics of reconstructive surgeries after radical interventions are shown.
The use of the onco-markers of malignant tumors at investigation of oncological diseases is connected to a number of the factors which are frequently not taken into account by laboratory service and practical doctors. Regional features and an arrangement in settlements of ecologically significant objects, and also the heredity on tumors of various localizations are among these factors. On the basis of studying of some onco-markers in blood of the women living in ecologically dangerous zones, the various laws of influence between the production factors on levels of their circulation are found.
Immune changes at surgical patients with a sepsis and multi-organ insufficiency are investigated. It is shown; that the development of the immune deficiency after surgeries are connected to development of a syndrome of system inflammatory reaction, immune regulation changes processes at a level of differentiation of T-helpers. The ratio of y-interferon and IL-10 at different stages of sepsis is investigated. The interrelation of this parameter c by a various degree of organ dysfunction is shown (used scale SOFA), depending on ronkoleukin therapy.
The treatment of benign diseases of a uterus cervix is an actual problem of gynecology, as on a base of benign diseases the malignant process can develop. 178 women with various pathology of the uterine cervix of fertile age were examined and have received cryo-destruction treatment. Advantages and high efficiency of this method are proved, as well as its importance for women waiting for pregnancy and delivery.
The morbidity by the prostate cancer tends to increase. Regional specificity of distribution of this pathology in territory of Siberia and the Far East is marked. In Western Siberia the morbidity on prostate cancer is higher than regional on 11.3%, in Eastern Siberia and on the Far East – is lower on 9.3% and 19.3% accordingly. In Primorsky Region the higher midannual rate of a gain of morbidity (7.6%) and mortality (7.3%) from this pathology is observed.
Authors had been used clinical, instrumental, biochemical methods for diagnostics of a chronic gastritis at adolescents. 145 adolescents with a chronic gastritis are surveyed. At 115 adolescents has been diagnosed a Helicobacter pylori (HP)-associated gastritis, for 30 adolescents – a reflux-gastritis. In patients with positive biochemical and serological tests find out morphological attributes of an inflammation of a mucous membrane of a stomach.
The analysis of quality of diagnostics of the uterine cervix cancer in the Central cytological laboratory of Vladivostok for 1992–2003 is done. Sensitivity of a method was 79%, specificity – 99.9% and diagnostic efficiency – 99.9%. The questions of standardization of results of cytological and histological research are discussed with the purpose of improvement of diagnostics of uterine cervix cancer.
The review of the literature and 10 own cases of malignant tumors of the small bowel. Complexities of diagnostics are emphasized. The description of two clinical examples is given.
Tactics of the emergency care on a material of 62 cases of the stomach cancer complicated with bleeding is described. It is marked, that endoscopic stop of the bleeding by coagulation has efficiency of 50% and should be added with the other procedures, including haemostatic therapy. Authors consider the embolization of the tumor vessels as a method of choice.
The brief review of clinical experience of tactics of melanoma treatment. At surgical excision of visually benign nevus the space in 1 cm from its edge is recommended. At melanoma the recommended space is not less than 3 sm. With the purpose of metastasizes findings the methods of lymphoscintigraphy, ultrasonography can be used, with the obligatory coloring of the tumor zone and regional lymph vessels.
192 cases of skin melanoma at all clinical stages of disease are analyzed. It is shown, that, by the development of relapses after the treatment, in 53.5% of cases there were clinically not diagnosed metastasizes in lymph nodes. The necessity of «watch» lymph node biopsy for correct diseases staging and tactics of treatment is emphasized.
The first experience of the esophagus stenting at oncological patients is generalized. In 14 cases the prosthetics by plastic stent, in 5 – by metal Z-stent is done. 10 patients have died of progressing of the oncological process within 9 months. Authors mark, that eno-prothesis adequately restores enteral feeding at patients with the local-spread esophagus cancer, providing improvement of quality of life in the first months after surgery, and allows carrying out the chemotherapy and radiology treatment.
PUBLIC HEALTH ORGANIZATION
The analysis of reports of the late staged cases of the malignant tumors in women has allowed authors to conclude that there are deviations from standards of diagnostics, control and treatment on all without exception stages of medical help. The reason of it, first of all, is insufficient education of primary care physicians and specialists of medical-treatment institutions of Khabarovsk on problem of early diagnostics of tumors of female reproductive sphere.
On a material of 1110 cases it is shown, that target prophylactic medical examination of the man’s population of risk group allows reducing the economic expenses connected to the late onset of treatment of prostate cancer. Basic factors at formation of groups of the oncological risk are the age, specific nutrition features, smoking and alcohol, occupational diseases, accompanying diseases, genetics. The algorithm of examination and treatment of prostate diseases is suggested.
Observed 144 children of preschool age attending preschool educational establishments, from them 89 children were the group of frequently ill. The immunologic analysis on the basis of tests of a level I and microbiological research of nasal and oral flora was done. At frequently ill children the decrease in the level of leukocytes and lymphocytes in peripheral blood, decrease in functional activity of phagocytes, increase of IgG level is revealed.
This work contains the analysis of distribution of patients on out-patient – polyclinic municipal establishments and hospitals, district and regional medical-prophylactic institutions. The results of the analysis testify the reduction in availability of medical help of a primary and secondary level in some of municipal institutions of Primorsky Region.
METHODS
The experience of endovideosurgical treatment of 280 inguinal hernias is shown. The important role of a diagnostic laparoscopy and non-tension plastics of the back wall of the inguinal channel is emphasized. The developed techniques of plastics of the difficult inguinal hernias allow providing small trauma of the interventions, reducing surgical time. It is emphasized, that endovideosurgical plastic of the difficult inguinal hernias provides favorable postoperative period, short terms of hospital treatment, good labor and social rehabilitation.
The outcomes of plastics of postoperative abdominal hernias with carbonaceous implantate «Carbonicus-I» at 43 patients are shown. Term of follow-up was till 9 years. Postoperative complications were found in 25 cases (58%): myocardium infarction with a lethal outcome, pneumonia, chronic bronchitis, seroma, skin necrosis, abscesses of abdominal wall and fistulas. Relapse of a hernia is marked at 6 patients (14%) with adiposity, ischemic heart disease, diabetes and hypertonia. Authors think that application of ”Carbonicus-I“ in treatment of hernias is not justified, as carbon materials, being sorbents, grasp microbes and toxins and provoke the development of an infection in a transplant zone.
In article the structure of the clot remaining after use of donor blood is investigated, and also an opportunity of its recycling. On the basis of scientific researches authors have got the patents for the method of fibrin producing from a blood clot, as well as on the methods of native fibrin powder producing and on the method of treatment of trophic ulcers by fibrin film.
The first experience of use epyluminescent microscopy in a combination with monitoring and digital technology of body carting in groups with high risk of melanoma development is described. At examining of 50 patients 4 melanomas were revealed. It is judged, that for active and early revealing of these tumors the creation of the specialized cabinet and screening programs is necessary.
The results of surgical treatment of 124 patients with postoperative ventral and inguinal hernias are shown. All patients underwent hernioplasty with «Ethicon’s» polypropylene mesh. The analysis of the short postoperative complications is done. There was no mortality in the group who underwent this type of surgery. For the period from 6 months till 2 years there were no relapses of hernias.
The analysis of 153 cytologies is done at various prostate diseases in comparison to the data of histological research. The results are: the high (up to 82%) sensitivity of a cytological method and its low specificity. The problems of increase of specificity of the method are discussed the improvements suggested by the use of reactions on cytoceratins, the protein of proliferating nucleus, proto-oncogene C-erbB-2, gene – suppressor p-53.