[The immediate results of bronchoplastic surgical operations in surgery for lung malignant tumors].

Bronchoplastic surgical operations by means of invaginated method on 1 semicircle in lung malignant tumors were performed in 124 patients. Of them 116 patients (93,5%) had primary and 8 patients (6,5%) metastatic tumors. There were 94 men (75,8%) and 30 women (24,2%). The average age of patients was 56,4. The lesion of the right lung was observed in 78 patients (62,9%), of the left one in 46 patients (37,1%). Bronchoplastic lobectomies were performed in 98 patients (79%), bilobectomies - 17 patients (13,7%), segmentectomy - 4 patients (3.3%), isolated resections of bronchi - 5 patients (4,0%). All operations were radical. In all cases of lung cancer there was carried out extended inpsilateral lymph node dissection. Complications of different severity were observed in 24 patients (19,4%): pneumonia (4,8%), atelectasis (0,8%), insufficiency of bronchial sutures (3.2%), granulation stenosis of the bronchial anastomosis (1,6 %), chylothorax (0,8%), recurrent nerve palsy (2,4%), heart rhythm disorders (2,4%). Postoperative lethality was 4.8%.

[Long-term results of isolated chemoperfusion of the lung with melphalan and cisplatin in combination with metastasectomy in treatment for resectable metastatic lung lesion].

For treatment of metastatic lung lesions there was used the method isolated chemoperfusion of the lung in combination with metastasectomy. The study includes 74 patients with metastases in the lungs who underwent 101 normothermal isolated chemoperfusion of the lung: of these 38 (37,6%) with melphalan and 63 (62,4%) with cisplatin without lethality. In the early postoperative period 1 (1,4%) patient died due to postperfusion lung edema. The period of observation of patients ranged from 2 to 99 months (median 29.3 months). Of 74 patients 53 (71,6%) patients are alive, 2 (2,7%) patients died from causes unrelated to the underlying disease. 43 (58,1%) patients showed progression of disease, what in 18 (41,9%) of them was the cause of death. Repeated appearance of metastases in perfused lung was detected in 30 (40,5%) patients. A 5-year disease-free (in the lungs) and observed survival of patients after isolated chemoperfusion of the lung with metastasectomy was 45% (median 46 months) and 59% (median not reached) respectively. There were established predictors of effectiveness of isolated chemoperfusion of the lung with metastasectomy: DFI> 13 months, ≤5 metastatic nodes in the lungs, the size of the largest metastasis in the lungs ≤20 mm, intralobular location of metastases in the lungs as well as the time of doubling the volume of metastases >64 days for chest computed tomography.

[COMPARATIVE EVALUATION OF SURGICAL APPROACHES TO TREATMENT OF PATIENTS WITH SKIN MELANOMA].

In recent years there has been rapid growth in the incidence of melanoma. Due to the large number of patients with various pigmented lesions, suspicious for melanoma, requiring differential diagnosis there is an actual problem of excisional biopsy in this group of patients. This review extensively covered approaches to radical surgical treatment of patients with skin melanoma. There are described in detail results of the studies of foreign experts regarding the influence of excisional and incisional biopsy on overall and disease-free survival rates of patients. On a large representative material (1126 patients) there are widely reflected the results of our studies to assess the effect of different surgical approaches to treatment of patients with skin melanoma. At present the authors can not recommend to perform excisional biopsy of patients with primary skin melanoma in oncological practice. Obviously for a final resolution of this problem it is necessary to conduct a multicenter randomized trial.

[PERFUSION TECHNOLOGIES IN TREATMENT OF PATIENTS WITH SKIN MELANOMA AND SOFT TISSUE SARCOMAS OF EXTREMITIES].

A steady increase of incidence of skin melanoma and soft tissue sarcomas of the extremities currently continues to be observed. Taking into account the high probability of developing of locally disseminated forms of skin melanoma and soft tissue sarcomas of extremities, the need to use combined methods in their treatment is quite high. In the 21st century the possibility of a use of isolated regional chemoperfusion provides a high objective response of tumor to chemotherapy without their systemic impact and improves the quality of life through preservation of the limb. This review describes the currently used drugs, and the results of ongoing clinical research in the world, as well as the results of our own study.

[Comparative assessment of the effectiveness of treatment for patients with lung cancer].

A total of 4218 lung cancer patients received therapy from 1965 to 2004. Patients' population analysis shows no statistically significant changes in sex, clinico-anatomical forms or morphological type structure. The first 30 years analyzed showed a gradual increase in the number of patients receiving radical treatment (46.7, 67.2 and 82.4% for each decade), in 1995-2004 this value dropped to 34,0%. For each of the decades studied was evident an increase in the number of patients over 60 years receiving radical treatment. The third decade (1985 to 1994) was characterized by statistically significant increase of 5-year overall survival among patients receiving radical treatment (49.0% compared to 36.2%, 37.6% and 46.0%) mostly due to an increase in I and IIA stage patients compared to other periods (67.9 versus 52.3, 56.5 and 51.6%). The adjuvant tele-irradiation (total focal dose 45-55 Gy, conventional fractioning) in patients receiving radical surgical treatment for metastatic lung cancer with mediastinal lymph nodes involvement (N2) lead to statistically significant increase in 5-year overall survival from 14.7 to 19.7%.

[Current problems in the combined therapy of lung cancer].

The paper describes the general experience of modern lung cancer treatment methods application. Neoadjuvant therapy was shown to improve the long-term results of stage III patients increasing the 5-year overall survival by 7,8% (p=0,012). The special diagnostic algorithm for treatment results evaluation including autofluorescence spectrometry with 97,1% sensitivity and 88,3% specificity was developed. The adjuvant external-beam radiotherapy in patients with mediastinal lymph nodes metastases was shown to increase the 5-year overall survival (14,7% versus 19,7%) (p=0,01). The combination of endotracheobronchial surgery with chemoradiotherapy allowed to increase the median survival time of patients with inoperable lung cancer to 17 months. Isolated lung chemoperfusion was shown to increase the overall (p=0,019) and relapse-free (p=0,005) survival in patients with lung metastases.

[Perspectives in use of surgery for disintegrating breast tumor].

Fifty-one patients with decaying breast cancer without signs of distant metastasis were operated on at the Academy's Clinic (September 2004 - December 2009). According to the 3-year follow-up, 18 out of 27 (62.5%) survived for 3 years and longer.

[Application of automated quantitative cytometry in diagnosis of lung cancer].

The paper deals with evaluation of the literature data and our experience with automated quantitative cytometric examination of sputum for diagnosis of lung cancer and, in particular, early one. This novel procedure uses measurement of quantitative indices which characterise tumors-induced alterations. The LungSign computerized system was employed to scan cellular nuclei. The results were evaluated by linear discriminative analysis with the aid of ROC-curves and underlying areas. The procedures were run in 248 cases and its sensitivity was significantly higher that of a standard cytological one (36.6% and 13.3%, respectively; p = 0.033), albeit a slight decrease in specificity (93.7% and 100%, respectively; p = 0.003). Automated quantitative cytometric indices varied significantly in cohorts of patients with confirmed (-0.275871) and false (-1.24990) diagnosis of lung cancer (p = 0.0001).

[Evaluation of efficacy of surgery for early lung cancer].

The efficacy of surgery for early lung cancer is generally high. Size of tumor remains a most significant factor of prognosis, alongside histological pattern, cell differentiation and extent of intervention, both in non-small- and small-cell lung cancer. Biological virulence of tumors measuring up to 2 cm and 2.1-3 cm varies, thus correlating with prognosis. Small-cell pattern, non-cell differentiation degree, extent of intervention, tumor size, history duration and gender are the most significant factors of prognosis in surgery for early lung cancer.

[Use of video-assisted thoracoscopy in diagnosis and therapy of single circular formations in the lung].

An evaluation is presented of the data on use of video-assisted thoracoscopy in the diagnosis and therapy of 45 patients with single circular formations in the lung. Indications and contraindications for the management of benign and malignant single tumors of the lung are discussed alongside a review of the Russian and foreign literature.

[Allelic distribution of the CYP1A1 in lung cancer patients, middle-aged tissue donors and in elderly people without cancer]. / Raspredelenie allelei gena CYP1A1 u bol'nykh rakom lëgkogo, donorov srednego vozrasta i pozhilykh liudei bez onkologicheskoi patologii.

The genetic polymorphism of metabolizers of tobacco smoke carcinogens can influence individual susceptibility to lung cancer. The study was concerned with the Mspl-polymorphism of the CYP1A1 gene responsible for encoding aryl hydrocarbon hydroxylase. It also plays a role in the activation of polycyclic aromatic hydrocarbons (PAH). The CYP1A1 alleles and genotype distribution in 146 lung cancer patients was compared with that in 230 healthy donors. Another control group consisted of 259 "cancer-resistant" subjects, i.e. tumor-free smokers and non-smokers aged 75 and more. The CYP1A1 allele incidence (19%) in patients with squamous lung cancer was significantly higher than in the control cohorts (11%) which is consistent with the leading role of PAH in the etiology of this pathology.

[Video thoracoscopy in the diagnosis and treatment of pulmonary, mediastinal and pleural neoplasia]. / Videotorakoskopiia v diagnostike i lechenii novoobrazovanii legkogo, sredosteniia i plevry.

Video-assisted thoracoscopy for differential and improved diagnosis was successful in 245 out of 249 patients (98.3%) with various chest neoplasms. Video-assisted surgical procedures were performed in 50 (20%). Complications were reported in 4 (1.6%). The method proved highly-effective as well as fairly safe and sparing.

[Polymorphism of the GSMT1 gene in lung cancer resistance and susceptibility]. / Polimorfizm gena GSTM1 v gruppakh predraspolozhennosti i rezistentnosti k raku lëgkogo.

The published studies of onco-associated genetic polymorphisms are characterized by insufficient interlaboratory reproducibility. The inconsistency of the results can be partially attributed to some characteristics of patients and control groups, which are used for the comparison of allele frequencies. For instance, many investigations involve so-called "healthy donors" as a standard. However, the efficiency of such a comparison can be questioned; indeed, as an individual life-time risk of malignancy reaches as high as 40-50%, a significant part of "healthy donors" would soon or later become the oncological patients. Here we tested the advantage of using "true" oncologically tolerant individuals as an additional control, e.g. tumor-free people, who succeeded to achieve an elderly age without signs of any neoplastic disease. GSTM1 gene polymorphism was used as a "positive control" for this novel design of molecular epidemiological study, as the GSTM1-null genotype displays slight but reproducible association with lung cancer risk. In the present investigation, GSTM1-deficiency was detected in 45% elderly tumor-free individuals, 55% healthy middle-aged donors, and 59% lung cancer patients. The minimal frequency (43%) of GSTM1(-) genotype was detected in elderly tumor-free smokers, and the maximal one (100%) was found in never-smoking lung cancer patients. Thus, the comparison of lung cancer patients to the "true" oncologically tolerant cohort (elderly tumor-free individuals, especially smokers) revealed more demonstrative deviations for the unfavorable genotype, than the traditional comparative analysis between oncological patients and healthy donors.

[Role of video-assisted thoracoscopy in diagnosis of neoplasms in mediastinal organs]. / Znachenie videotorakoskopii v diagnostike novoobrazovanii organov sredosteniia.

Diagnostic potential of video-assisted thoracoscopy was evaluated in 66 patients (36 males and 30 females) with neoplasms (aged 24-68 yrs). When used in conjunction with biopsy, it confirmed the following diagnoses: lymph proliferative disease (23), mediastinal malignancies (11), sarcoidosis (21), benign mediastinal tumors (7), Castleman's benign lymphoma (2) and mediastinal cyst (2). Clinical diagnosis was substantially changed in 40 (61%) cases as a result of videothoracoscopy application. It has proved precise, fairly safe and conservative; it has a potential in diagnosis of mediastinal tumors.

[Current methods in the diagnosis and therapy of lung cancer]. / Sovremennye podkhody k diagnostike i lecheniiu raka lëgkogo.

A 45-year experience of diagnosis and treatment of lung cancer is presented. In groups at high risk of cancer, photoroentgenographic screening has proved effective. The use of out-patient complex pulmonologic examination serves to improve identification of central cancer. Early cancers of the lung can be reliably detected in 92.2% of patients with central cancer and in 92.6%-peripheral localizations of tumor. After radical surgery, 5-year survival in cases of stage I tumor was 63.5: stage II-43.5 and stage III-22.9%, mean 5-year survival (irrespective of stage) being 37%. Postoperative radiation was shown to be followed survival over 5 years in cases of non-small cell carcinoma (N2). Early diagnosis and combined therapy are key in raising efficacy of lung cancer treatment.

Alkylation and oxidative-DNA damage repair activity in blood leukocytes of smokers and non-smokers.

The levels of 3 DNA repair enzymes involved in alkylation and oxidative DNA damage repair in human peripheral blood leukocytes were measured in 20 smokers and 17 non-smokers. No differences in O6-alkylguanine-DNA-alkyltransferase (AGT) activity were found between the 2 groups and the AGT distribution within the population appeared to be unimodal. In contrast, the mean activities of both the methylpurine (MeP)- and the 2-6-diamino-4-hydroxy-5N formamidopyrimidine (FaPy)-DNA glycosylases were higher in the smokers, although only the difference between the MeP-DNA glycosylase means was statistically significant. The standard deviations of these 2 enzymes were also higher in the smokers. The MeP-DNA glycosylase activity showed a bimodal distribution when all subjects were considered. This may in part be due to the smoking habit; 83% of the subjects with enzyme activities higher than 500 fmoles/mg protein were current smokers, whilst 85% of the non-smokers had lower enzyme activities. However, if the smokers were considered separately, a bimodal distribution of this enzyme activity could still be observed. No strong correlation was observed between enzyme activity and age, although the slopes of the regression lines of enzyme activity on age were all negative. The relationship between enzyme activities was studied by bivariate distribution and a strong correlation was only found between the MeP-DNA glycosylase and the FaPy-glycosylase, with the highest values of both enzyme activities being observed in the smokers and the lowest in the non-smokers. Our results suggest that the activity of certain DNA repair enzymes can be modulated by environmental exposure.

[The role of the constitutional features and rearrangement of the H-ras 1 oncogene in the development of human lung cancer]. / Rol' konstitutivnykh osobennostei i perestroek onkogena HRAS 1 v razvitii raka legkogo cheloveka.

Length polymorphism of restriction fragments of oncogene HRASI was studied in 52 patients with lung cancer as compared with corresponding normal tissues and leukocytes of these patients and of healthy volunteers. Enhanced frequency of one of main alleles of HRASI A4 was found to correlate with development of the disease aggressive symptoms. Alterations in the HRASI locus of tumoral DNA appear to correlate distinctly with the elevate frequency of the allele (P less than 0.01). Relationship between the allele A4 and active metastases spreading in lung cancer of the III-IV stages as well as specific rearrangements as a result of which allele A4 maintained unaltered or even amplified in carcinomas enabled to suggest that the allele A4 of HRASI oncogene serves as an endogenous risk factor in impairment with non-small cellular lung cancer in addition to typical exogenous factors such as smoking.

[The clinical x-ray diagnosis of pulmonary hamartomas]. / Kliniko-rentgenologicheskaia diagnostika gamartom legkikh.

A clinico-roentgenologic study of 67 patients with hamartoma of the lung was carried out. Hamartoma could not be even suggested unless X-ray examination was performed but even this procedure sometimes failed to identify the disease. It was far from being each case that typical roentgenologic features of hamartoma were observed. Transthoracic needle biopsy may be helpful in identifying the nature of a roentgenologically detected tumor. Roentgenologically, hamartoma should be first of all distinguished from peripheral lung cancer. When clinico-roentgenologic and needle biopsy data are inconclusive with respect to lung cancer diagnostic thoracotomy should be performed.