[Combined use conventional and videoendosurgery in pediatric oncology].

The autors report original date on the combined use of videosurgery and open surgical intervention in 3 patients. One (1 yr 10 mo) had neuroblastoma in the posterior mediastinum spreading to the retroperitoneal region, another (5 yr) presented with neuroblastoma in the thoracic aperture region spreading to the neck, the third one (14 yr) suffered limphoepithelioma-like cancer of the thymus. The combined treatment permits to optimize the surgical procedure and avoid additional use of thoraco- and laparotomy.

[Histogenesis of infantile fibrosarcoma].

Eight cases of infantile deep soft tissue fibrosarcoma were examined. The tumor consists of neoplastic fibroblasts and myofibroblasts which differ from each other ultrastructurally. Well-differentiated collagen-forming neoplastic fibroblasts form one-half of infantile fibrosarcoma. Immunohistochemically and ultrastructurally immature embryonic-like fibroblasts were also identified. The latter closely resemble an embryonic perichondrial fibroblast of the embryonic limb during 6 weeks of development.

[Clinico-morphological peculiarities of thyroid cancer among children exposed to the Chernobyl disaster radiation].

The paper deals with a comparison of clinico-morphological patterns of sporadic thyroid cancer and that in pediatric patients exposed to radiation during the Chernobyl disaster. The latter are highly prone to both local and regional metastatic spread to the lymph nodes (intrathyroid distribution--61%; extension through capsule--42%, and metastases to the neck lymph nodes--66%). However, these data do not differ significantly from those for intact areas. Yet, cancer occurs in exposed cohorts at an earlier stage: its incidence at age 4-6 is 2-3.5 higher and that of relapse such as presentation of latent metastases to the lymph nodes and tumor foci development in residual tumor tissue is 1.6 times the average. Also, morphological patterns have changed: typical papillary cancer incidence has dropped by half while the diffuse follicular variety has grown 1.8-fold.

[Diagnosis of micrometastases of alveolar rhabdomyosarcoma].

Alveolar rhabgomyosarcoma is a highly malignant, small blue cell pediatric soft tissue tumor. Identification of micrometastases in alveolar rhabdomyosarcoma is important because the poor prognosis associated with this subgroup necessitates a modified therapeutic regimen. Since the obtained lymph node specimen can be very small; rhabdomyosarcoma cells are not easily detected using conventional histological methods. To assess the value of myogenin staining in the diagnosis of micrometastases in alveolar rhabdomyosarcoma, the authors examined 36 lymph nodes from children bearing this tumor. Occult tumor cells were detected in 8 cases. The PAX3/7-FKHR gene fusion that resulted from chromosomal translocation in alveolar rhabdomyosarcoma provided potential molecular diagnostic markers. Reverse-transcriptase polymerase chain reaction (RT-PCR) was used to develop an assay capable of identifying RAX3/7-FKHR positive cells in the fresh lymph nodes. Thirty-six lymph nodes were examined and of them 17 lymph nodes had PAX3/7-FKHR fusion transcripts of alveolar rhadomyosarcoma cells. The study demonstrates that molecular RT-PCR detection of micrometastases is the most sensitive method for diagnosing alveolar rhabdomyosarcoma.

[Ototoxic effect and its prevention in administration of cisplatin]. / Ototoksicheskoe deistvie tsisplatina i vozmozhnosti ego profilaktiki.

Short-latent acoustic evoked potentials were registered in examination of hearing function in guinea pigs given platinum compounds. A protective action of thiol compounds (sodium thiosulfate and unitiol) was tried in relation to hypoacusis induced by cisplatinum.

[Modern prospects for polychemotherapy of solid neoplasms in children]. / Sovremennye vozmozhnosti polikhimioterapii solidnykh zlokachestvennykh opukholei u detei

To improve life quality and to increase survival in children with solid tumors, emphasis is placed on chemotherapeutical treatments along with other existing ones (surgery, radiation). By taking into account the fact that most malignant tumors in children are highly responsive to chemotherapy, programme treatment in children with neoplasms included the new drugs iphosphamide, vepeside, cisplatin, carboplatin, melfalan, bleomycin. The results of therapy with these drugs alone or in combination with well-known effective anthracycline antibiotics and plant preparations are presented. Whether more rigid modified schemes for administration and increment of dosage can be used is shown. This investigation opens new vistas for treating patients with not only localized, but disseminated forms of tumors, such as nephroblastomas, germinogenic tumors, soft tissue tumors, tumors of the bone, head, and neck. Regular assessment of the existing programmes in order to amend them, the use of new drugs, the increase of dosage and administration regimens enhance promises in treating malignant tumors in children.

[The vaccination of children with severe somatic pathology]. / Vaktsinatsiia detei s tiazheloi somaticheskoi patologiei.

1,696 children were vaccinated; of these, 1,487 children had different kinds of somatic pathology, including 1,181 children with CNS lesions, 29 children with malignant tumors, 45 children with congenital defects, 82 children with allergic diseases, etc. The group of relatively healthy vaccinees consisted of 209 children. The following vaccines were used for immunization: Tetracoq 05, D.T.Vax, Rudivax, Imovax Polio, Vaxigrip (Pasteur Mèrieux Connaught, France); HBVax, MMRII (Merck Sharp & Dohme, USA); as well as vaccines against hepatitis B produced by Smith Kline Beecham (UK) and Combiotech (Russia). In no case severe vaccine-associated complications were observed. The frequency and manifestation of reactions in children with somatic pathology did nor essentially differ from those in relatively healthy children. The increase of the number of vaccine components did not lead to the increase of the number of side effects of the severity of their manifestation. These investigations demonstrated the safety of vaccination for children with somatic pathology.

[Treatment modalities and results of comprehensive therapy for extended retinoblastoma in children]. / Lechebnaia taktika i rezul'taty kompleksnogo lecheniia retinoblastomy u detei v rasprostranennykh stadiiakh zabolevaniia.

New procedures of laser therapy and chemotherapy have extended the scope of application of organ-saving treatment at advanced stages of retinoblastoma in childhood, thus making it possible to preserve the eye fully functional or cosmetic. Not having to perform such mutilating procedures as ophthalmectomy or eye socket exenteration contributes to psychological and physical rehabilitation. At the same time, as a comparison of the results of surgery carried out at initial stages and surgery-free treatment showed that palliative therapy is characterized by impressive rates of 5-year survival. New vistas have opened of in the management of pediatric retinoblastoma, particularly in cases of stage III tumor and bilateral involvement.

[Multimodality treatment for retinoblastoma in children]. / Kompleksnoe lechenie retinoblastomy u detei.

A comprehensive programme was developed for the treatment of uni- and bilateral retinoblastoma in children with due regard to the disease stage by the TNM system. The use of the current sources of teletherapy and cyclic polychemotherapy expanded indications for organ-saving therapy at most common stages. Treatment by the program was performed in 202 patients, including 125 children with unilateral damage and 77 with bilateral damage. An attempt made treat 140 (75%) children at the first stage. More than 70% of cases were diagnosed as having disease stage T3 in one or two stage, while such patients underwent ocular enucleation. A complete or partial (more than 50%) tumor regression without signs of its progression for 2 years or more was achieved in 62% of cases. At the first stage of therapy, conservative therapy insignificantly affected the children's longevity in uncomplicated cases, which is particularly important in bilateral involvement, while this preserved the organ of vision in more than half the patients (62%). Five-year survival was 92 and 82% in unilateral retinoblastoma surgically treated and untreated, 83 and 84%, respectively. Adequate multimodality treatment brought about low incidence rates of recurrence and metastasis (10%) in conservative therapy and 7.7% among all patients.

[Evolution of drug treatment of rhabdomyosarcoma in children]. / Evoliutsiia lekarstvennogo lecheniia rabdomiosarkom u detei.

Rhabdomyosarcoma is the most frequently occurring type of malignant solid tumors in children. The tumor site, aggressive growth, proneness to recurrence, metastatic spreading, and high neglect predetermine the negligible share of the surgical method in multimodality treatment of rhabdomyosarcomas. Of importance are the development and the use of different types and schemes of drug therapy which can be employed in combination with radiotherapy. Drug therapy of rhabdomyosarcomas has large practical potentialities which rise from year to year.

[Rhabdomyosarcoma in children]. / Rabdomiosarkomy u detei.

Issues in diagnosis and complex treatment of pediatric rhabdomyosarcoma were studied in 198 patients with morphologically verified disease. Tumors most often developed in the genitourinary organs (36.6%), head and neck (37%) and--less frequently--on the trunk and extremities (26.4%). The diagnostic workup included instrumental methods, ultrasonography and computed tomography. All modern modalities of cancer treatment, viz. surgery, drug and radiotherapy were used in those patients. As a rule, treatment was either combined or complex. Two-year-survival rate ranged from 83% for rhabdomyosarcoma of the orbit to 50% for those of the trunk and extremities and 47% for head and neck neoplasms. Two-year survival for patients with rhabdomyosarcoma of non-genitourinary sites was 54%.