[Morphological analysis of the structure of parafistulous tissues in patients with vesicovaginal fistulas by the local interstitial application of platelet-rich plasma].

The issue of complications of fistuloplasty of vesicovaginal fistulas (VVF) remains extremely relevant both for modern surgeons and for patients. Optimization of morphological characteristics by local interstitial application of Platelet-Rich Plasma (PRP) can positively affect the results of surgical treatment of VVF. PURPOSE OF THE STUDY: to conduct a comparative assessment of the morphological parameters of parafistulous tissues before and after local interstitial application of PRP. MATERIALS AND METHODS: Study included 52 patients who underwent fistuloplasty. Group I included 30 women who were treated according to the standard method. Group II included 22 patients who underwent PRP therapy prior to surgery. All patients underwent an excisional biopsy of the VVF edges. After performing an excisional biopsy, Group II patients received 9-10 parafistulic injections of activated PRP with a frequency of one every seven days for five weeks before fistuloplasty. Repeated biopsy of the VVF edges was performed in Group II patients immediately before fistuloplasty. For histological study, tissue sections were stained with hematoxylin and eosin according to standard technology. RESULTS: Primary biopsy revealed keratinization disorders in eight (37 percent) patients from Group II, and after PRP therapy in four (18 percent) patients (p>0.05). In all patients of Group II, after PRP therapy, the epithelial layer had a normal histological structure (p<0.05). Erosive and ulcerative lesions of the integumentary epithelium were initially detected in 14 patients (64 percent) from Group II. No erosions were detected during control biopsy (p<0.05). The thickness of fibrous tissue in Group II before the therapy was 886.3+/-113.5 M, and 830.1+/-119.9 M (p=0.66) after. Lymphoid infiltration was initially present in 20 patients from Group II, in eight of them (40 percent) it decreased (p<0.05) after the therapy. Cell density decreased after PRP therapy in 11 patients (50 percent), but in four (18 percent) patients it increased from low to moderate (p<0.05). Microvascular density before therapy was 29+/-3,3, and 19.9+/-1.9 after. The difference has statistical validity at the trend level (p=0.078). CONCLUSION: Taking into account a statistically significant decrease in the activity of the inflammatory process, complete relief of erosive and ulcerative lesions, and decrease in the thickness of fibrosis in the stromal layer in fistula tissues, application of PRP therapy in the surgical treatment of VVF should be considered appropriate and justified.

[The distal resection margin in rectal cancer surgery].

Spread of the tumor in the distal direction is an important factor that must be considered when performing organ-serving surgery for rectal cancer. Particular relevance it has acquired in recent years due to the general tendency to expand the indications for the preservation of natural reflex-apparatus in patients with medium- and lower-ampullar part of the rectum.

[Prognostic value of markers for proliferative activity and apoptotic regulation in laryngeal squamous cell carcinoma].

Prognosis for patients with laryngeal squamous cell carcinoma depends on many factors, among which molecular biological markers receive ever increasing attention. The purpose of this study was to determine the prognostic value of the expression of the proteins p53 and bcl-2 and the proliferation markers Ki-67 and cyclin D1 in laryngeal squamous cell carcinoma. Biopsy specimens from 64 patients aged 34 to 77 years (mean age 56+1.2 years) with invasive laryngeal squamous cell carcinoma, who received combination therapy at the Medical Radiology Research Center, Russian Academy of Medical Sciences, were studied. The level of Ki-67 and the expression of cyclin D1, p53, and bcl-2 were compared with clinical and anatomic parameters (T stage, tumor grade, and the presence of regional metastases), using Student's t-test and fourfold table analysis (X2 or Fisher's exact test). Survival rates were analyzed by the Kaplan-Meier method; the significance of differences between survival curves was confirmed by Cox's F-test. The value p0.05 was taken to be significant. Ki-67 is an important prognostic marker for the N status (p=0.03) and recurrence (p=0.04) and a marker for tumor grading (p<0.01). Cyclin D1 expression is associated with low overall and relapse-free survival rates (p=0.05 and 0.03, respectively). The prognostic marker for a recurrence is p53 (p=0.01) that is related to the N status at the trend level (p=0.08). The marker bcl-2 is associated with high overall survival (p=0.01) and N status at the trend level (p=0.08).

[Angiogenesis in laryngeal squamous carcinoma and its prognostic significance].

Prognosis for laryngeal squamous carcinoma patients depends on numerous factors, and tumor-related angiogenesis is one of them. Our study was concerned with prognostic significance of intra-tumor vascular bed in such patients. Bioptic material was sampled from 61 patients, aged 34-77, after combined treatment at the Center's Clinic. Microvascular density, overall perimeter of vascular wall and overall vascular area were compared with such clinical characteristics as T stage, tumor cell differentiation and presence of regional metastases using t-test (Student) and contingency tables (2x2) (chi2, Fisher's accuracy criterion). The Caplan-Meyer method was used to evaluate survival and Cox F-test--to assess survival curve difference significance (p < or = 0.05). The angiogenesis pattern proved a significant prognosticator for relapse, relapse-free and specific survival.

[Low-grade fibromyxoid sarcoma: analysis of 8 cases].

The diagnosis of low-grade fibromyxoid sarcoma was made in 8 patients. The lesions were 2-17 cm in the lower extremities and trunk. One patient had a long history of painless subcutaneous and intramuscular mass (median 1 year). All tumors showed predominantly the typical hypocellularity and cytologic features of typical low-grade fibromyxoid sarcoma; however, the areas of hypercellularity and nuclear enlargement and hyperchromatism were identified. No necrosis and mitotic activity less than 2 mf/50 HPF were present. Ultrastructurally, the tumor composed of neoplastic fibroblasts. No other cell differentiation was identified. Immunohistochemically, the neoplastic cells showed a positive response to vimentin and fibroblast antigen; no muscle-specific antigens were revealed. The Ki-67 labeling index with MIB-1 ranged 2-6%.

[Ki-67 and p53 expression as prognosticators of clinical course aggressiveness of squamous cell cancer of the larynx].

The study used bioptic sampling material from 64 patients with invasive squamous cell cancer of the larynx, aged 34-77 (mean age--56 +/- 1.2), receiving combined treatment at the Center's Clinic, Obninsk. Ki-67 and p53 levels were assayed vs. such clinico-anatomical parameters as tumor size, cell differentiation grade and presence of regional metastasis. The study revealed a significant direct correlation between Ki-67 index, on the one hand, and tumor size, tumor cell differentiation and relapse, on the other. p53 expression in tumor tissue was associated with a relatively high incidence of relapse (p = 0.01). Both markers may be used as prognosticators of survival in laryngeal cancer.

Craniopharyngioma of the pineal region.

Craniopharyngiomas generally develop either in the suprasellar region or in both suprasellar and intrasellar regions. We report on a nontypical location of the craniopharyngioma in the pineal region. An 8-year-old boy was admitted to the department of pediatric neurosurgery in a grave condition. An MRI scan of the brain was performed after the neurological examination and revealed a large neoplasm situated in the posterior part of the III ventricle and in the pineal region, measuring 8.5x6.5x5 cm. The size of the tumor and its location meant it was occluding three ventricles, with subsequent hydrocephaly. Total removal of the tumor was carried out. Microscopic investigation of the tissue removed showed the typical structure characteristic for craniopharyngioma of the adamantinomatous type. Results of a consultation 6 months after the operation revealed that the patient was feeling well, attending school regularly and had finished the first semester with excellent results. On control MRI scan no tumor was found.