[The treatment of nonorganic neoplasms of the lesser pelvis]. / Lechenie bol'nykh neorgannymi novoobrazovaniiami malogo taza.

In 1967-1989, 330 patients with non-visceral tumors of the small pelvis (children--110 and adults--220) were registered. One hundred and five patients, 17 children included, presented with benign tumors whereas 225 (children--93 and adults--132)--with cancer. Absolute and relative, local and general contraindications to surgery were outlined. The most important criteria are the extent of tumor, patient's status, equipment and surgical skills. Tumors were approached through 9 different accesses depending on their size and site. Surgery wat performed in 242 patients, viz. 89.5% of patients with benign tumors and 65.7% of those with cancer. The percentage of operated children (37.6%) was much lower than that of adults (85.6%) since the former presented with more advanced tumors. Radical surgery was performed in 192 (79.3%) patients; benign tumors were removed in 86.7% whereas cancer--in 44.9%. Complications were encountered in 56.2% of cases, bleeding being the most frequent one (47.0%). Lethality following radical surgery was 3.1%. Radiation and chemotherapy alone proved ineffective. Complex treatment assured better clinical course. One-ten-year survival rate in adults with malignant tumors was 51.2%-31.8%. As few as 17.2% of children survived one year whereas only 6.5%-2 years which points to more aggressive clinical course of malignant non-visceral tumors of the small pelvis in children.

[The possibilities of using the free polyamines of the peripheral blood as biochemical tumor markers in nephroblastoma in children]. / Vozmozhnosti ispol'zovaniia svobodnykh poliaminov perifericheskoi krovi kak biokhimicheskikh opukholevykh markerov pri nefroblastome u detei.

Thin-layer chromatography was used to measure free polyamine level in blood plasma and peripheral blood cells in 38 pediatric nephroblastoma patients and 30 apparently healthy children. Thirty-six nephroblastoma patients were examined in the course of treatment of whom 25-during 1-36 months following basic treatment course as well. A significant increase in the initial free polyamine level in blood cells (92.4% of cases) and plasma (63%) of nephroblastoma patients was observed. A correlation was established between changes in free polyamine level, on the one hand, and response to treatment and subsequent course of disease, on the other. At 8-10 days following radical surgery, a decrease in polyamine level was observed in 58% of operated cases and an increase-in 41.8%. The latter proved prognostically unfavorable. Recurrence and metastases development was associated with a rise in polyamine concentration in plasma and, particularly, in blood cells which in some cases preceded the appearance of other signs of tumor progression. The polyamine test can be recommended for monitoring pediatric nephroblastoma patients.

[Pelvic exenteration as a means of improving the resectability of advanced cancer of the rectum]. / Evistseratsiia taza kak sposob povyshehiia rezektabel'nosti raka priamoi kishki.

The paper discusses the results of treatment of 10 male patients who underwent pelvic evisceration for advanced rectal cancer. Surgical technique is described. In 9 cases, an isolated ileocecal "urinary bladder" was formed; in 1 patient urine was passed into a small intestine segment. The involvement of the urinary bladder and/or the prostate were observed in 6 patients. One patient died shortly after surgery, three--within the first 12 months and another 2--during the second year. Four cases have survived over 5 years, 3 of them surviving over 10 years.

[The complex diagnosis of nonorganic neoplasms of the small pelvis]. / Kompleksnaia diagnostika neorgannykh novoobrazovanii malogo taza.

The paper discusses the results of examination of 205 cases of extra-organ tumors of the small pelvis carried out in 1967-1986. The study group included 65 pediatric and 140 adult patients, 57 (28%) males and 148 (72%) females, 194 primary and 11 relapsing cases. Patients aged under 4 years (47, i. e. 23%) prevailed. Benign tumors were detected in 83 (40.5%) and malignant ones--in 122 (59.5%) cases. Disease was asymptomatic in 39 (19.0%) patients and presented with multiple symptoms in 166 (81.0%). Rectally, the upper pole of lesion was palpable in 47 (22.9%) while the lower one--in all cases. Tumors which took up as much as two-thirds of the small pelvis cavity were found in 37 (56.9%) pediatric and 31 (22.1%) adult patients. Tumorous or secondary lesions of adjacent organs were detected rectoscopically in 47 of 74 (63.5%) cases: sensitivity (s)-88.6%, specificity (sp)-57.1%; using chromocystoscopy--in 43 of 64 (67.2%): s-89.5%, sp-75.0%; pelvic pneumography-31 of 56 (55.3%): s-68.8%, sp-54.5%; excretory urography-53 of 79 (67.0%): s-88.3%, sp-68.4%; irrigoscopy-55 of 79 (69.6%): s-82.4%, sp-75.0%; angiography-30 of 70 (42.8%): s-90.9%, sp-78.4% and computer tomography--in 42 of 45 (93.3%) patients: s-96.4%, sp-88.2%. Four stages of diagnosis were suggested.

[Suppression of thymus endocrine function and changes in the plasma membrane properties of the lymphocytes in the chemotherapy of systemic oncological diseases in children]. / Ugnetenie éndokrinnoi funktsii timusa i izmenenie svoistv plazmaticheskoi membrany limfotsitov pri khimioterapii sistemnykh onkologicheskikh zabolevanii u detei.

An examination of 16 children suffering from malignancies established marked chemotherapy--induced suppression of endocrine function of the thymus. These findings were in correlation with variations in peripheral blood lymphocytes level in spontaneous rosette-formation test with ovine red blood cells and autoerythrocytes. The levels of E- and A-rosette-forming cells returned to normal following in vitro incubation of peripheral blood lymphocytes with thymostimuline. It is suggested that immunocorrection by means of thymal hormones should be carried out in the course of chemotherapy.

[Surgical approaches to the treatment of nonorganic pelvic neoplasms]. / Khirurgicheskie dostupy k neorgannym novoobrazovaniiam malogo taza.

Operations were performed on 242 patients (49 out of 110 children and 193 out of 220 adults) with nonorganic new growths of the true pelvis. Nine surgical approaches were used: transperitoneal (89 patients), transperitoneal-unguinal-femoral (2), extraperitoneal (48), transgluteal-transsacral (23), parasacral (14), transuterine (4), interlabial (2), perineal (16), combined (44). The transperitoneal approach was used most frequently--in 52.0% of patients (taking into account the combined approach), more often in children than in adults, and more often in males than in females. The choice of the approach was mostly guided by the location and size of the new growth in the true pelvis.

[The diagnosis of nonorganic neoplasms of the lesser pelvis]. / Diagnostika neorgannykh novoobrazovanii malogo taza.

An analysis is presented of the data on 330 patients with extraorganic neoplasms of the small pelvis (ENSP), 110 of whom are children, 105 subjects had benign neoplasms, 225 presented with malignant neoplasia. ENSP are manifested primarily by pains in the pelvis and disturbances in physiological functions due to the adjacent organs and structures being squeezed. In applying for medical advice for the first time diagnostic procedures fail to show ENSP in each third (34.2%) patient. The diagnosis of ENSP is supposed to include several studies and it is multi-stage. The most valuable information concerning ENSP is provided by rectal and/or vaginal examination of pelvic cavity. A scheme was elaborated for establishing boundaries of the focus, determining the size of a neoplasm, as was the classification according to the stages and TNM system for the objective information to be obtained on localization, size and distribution of a neoplasm. Employed in the evaluation of patients were rectoscopy (in 158 patients), cystoscopy (123), roentgenography of bones and pelvic cavity (306), pelvic pneumography (79), excretory urography (175), rectosigmoidography (178), ultrasonography (102), computerized tomography (118), angiography (112) and other procedures, all these having been done in order to be able to make as accurate and precise a diagnosis as possible.

[Combined interventions in non-organic neoplasms of the small pelvis]. / Kombinirovannye vmeshatel'stva pri neorgannykh novoobrazovaniiakh malogo taza.

Experience with 62 combined operations on patients with nonorganic new growths of the true pelvis is discussed. They accounted for 33.3% of 227 radical interventions undertaken for this disease. The ages of the patients ranged from 4 months to 64 years. Ten patients were admitted after exploratory laparotomies. Benign new growths were diagnosed in 14 and malignant new growths in 48 patients. Different variants of operative approaches were used. Most frequently the tumor was resected together with bones, iliac vessels, genitalia, and urinary bladder. Various complications were noted in 39 patients who were operated on. Hemorrhage was the most frequent and menacing complication--in 26 patients. Two patients died. Recurrences were found in 8 of a group of 60 patients discharge from the clinic. After combined operations for malignant nonorganic tumors of the true pelvis 3-year survival was 36.0%, 5-year survival was 29.4%.

[Aggressive fibromatosis of the small pelvis]. / Agressivnyi fibromatoz polosti malogo taza.

Experience in the treatment of 25 patients with aggressive fibromatosis of the true pelvis is discussed. To establish a precise diagnosis obligatory and special methods of examination were applied. Secondary changes in the adjacent organs and structures were found in 24 patients. Radical operations were conducted on 19 (76%) patients, in 13 of them the interventions were combined. The mean duration of the operations was 5.3 hours. Complications developed in 17 out of 19 patients. Hemorrhage was the most frequent (in 12 out of 19 patients) and menacing complication. The blood loss was 3036.8 ml on the average. Recurrences were registered in 8 out of 19 (42.1%) patients.

[Postoperative complications in patients with a perforated gastroduodenal ulcer]. / Posleoperatsionnye oslozhneniia u bol'nykh s perforativnoi gastroduodenal'noi iazvoi.

The results of treatment of 538 patients, operated on for perforative ulcer (PU), are studied up. Perforative aperture was sutured in 75 patients, in 153 the ulcer was excised, in 291 the excision was supplemented by vagotomy, resectional methods were applied in 19. In 94 (17.5%) of patients 114 complications have occurred after the operation. Postoperative complications were divided into those from the wound, in the abdominal cavity organs and retroperitoneal space, from the abdominal cavity, respiratory and cardiovascular system. After the operation 37 (6.9%) of patients have died. Complications and mortality were observed more frequently in the patients to whom the perforative aperture suturing and the ulcer excision with truncal or selective vagotomy were conducted in the presence of the increased operative risk (the elderly and senile age, concurrent diseases, widespread peritonitis). The least frequency of postoperative complications and mortality were noted after the PU and the ulcer substratum excision supplemented by selective proximal vagotomy.

[Relaparotomy]. / Relaparotomiia.

For a period of 1987-1995 yrs. the operations on a peritoneal cavity organs were performed in 14,718 patients. In 87 reoperated patients 93 relaparotomies were conducted. After relaparotomy 36 (41.3%) patients died.