[Biological role of carnosine and its use in ophthalmology (mini-review)].

Carnosine (beta-alanyl-L-histidine) exhibits various biological effects underlying its potential therapeutic use. In ophthalmology carnosine was effective in treatment of corneal metabolic diseases, senile cataract. It accelerated cornea reepithelization after photorephraction ceratoectomia.

CYP19 gene expression and aromatase activity in endometrial cancer tissue: importance of the type of the disease.

Aromatase (CYP19) activity in malignant endometrium presents local mechanism with potential ability to support tumor growth. The data on interrelation between activity of this enzyme and its mRNA signal in endometrial cancer (EC) tissue are very scarce and inconclusive. To correct this gap we studied aromatase activity and gene expression totally in 19 samples of EC (17 of them -- from postmenopausal women) collected during surgery. Aromatase activity was evaluated by tritium water release assay and CYP19 gene expression -- with rt-PCR. Additionally, all studied EC cases were divided on the basis of case history and some characteristics of host and tumor and in accordance with existing classification into cases belonging to type I or II of the disease (correspondingly, 13 and 6 observations). Positive correlation between enzyme activity and CYP19 mRNA signal (R(s)=+0.63, p<0.05) was revealed in the whole group of studied samples. Aromatase activity varied in evaluated material between 1.45 fM/mg prot./hr and 11.49 fM/mg prot./hr, and in type II cases it was higher (7.27+/-0.96 fM/mg prot/hr) than in type I observations (4.96+/-0.66 fM/mg prot./hr, p=0.066). CYP19 mRNA expression was not revealed in 6 cases and all of them belonged to the type I of disease. Thus, although type II of EC is frequently considered as hormone non-dependent, increased ability of this tumor type to estrogen biosynthesis (on CYP19 gene and protein level) may lead to reconsideration of such conclusion and warrants further investigation.

[Diseases of fatty appendices of the colon]. / Zabolevaniia zhirovykh podveskov obodochnoi kishki.

Seventy-one patients with volvulus of fatty appendix of the colon (sigmoid colon--52 patients, caecum--12, ascending colon--5, vermicular appendix--2 patients) were treated. Volvulus of epiploic appendix was seen in 67.6% operated patients, inflammatory changes--in 28.1% (primary inflammation was diagnosed in 4.2% patients). Symptoms of fat metabolism disorders were detected in 44 patients. There are no specific symptoms. Diagnostic laparoscopy permitted to improve diagnosis of epiploic appendices diseases. Target surgical approach permitted to reduce rate of postoperative complications and to improve results of treatment.

[Genetic polymorphism of steroid 17 alpha-hydroxylase/17,20-lyase (CYP17) and hyperinsulinemia in endometrial carcinoma]. / Polymorfism gena steroid-17-al'fa-gidroksilazy/17,20-liazy (CYP17) i giperinsulinemiia pri rake tela matki.

Initiation and/or promotion of endometrial carcinoma is considered to be associated with estrogens and androgens (androstendione) excess as well as hyperinsulinemia and resistance to insulin. It is possible that certain polymorphisms of the genes involved in steroidogenesis or steroid metabolism contribute to carcinoma susceptibility. In the current study, we compared the role of CYP17 biallelic MspA1) polymorphism in 114 endometrial carcinoma patients and 182 healthy women. According to our data, A2/A2 CYP17 genotype traditionally regarded as "unfavorable" was less frequent in cancer patients than in control which confirmed the results of two previous publications. For the first time, carriers of the genotype were shown to have relatively low levels of blood insulin and C-peptide. No significant difference was found between mean concentrations of testosterone, dehydroepiandrosterone sulfate and those of estradiol in the carriers of various CYP17 genotypes with endometrial cancer. Hence, CYP17 polymorphism which is represented by the "normal" A1/A1 genotype might be a factor of risk for endometrial carcinoma. Since this genetic variety may develop through an unconventional (nonsteroid) pathway, taking relevant preventive measures in high-risk groups should be recommended.

[Results of radiotherapy and combined, comprehensive treatment of pancreatic cancer]. / Rezul'taty luchevogo, kombinirovannogo i kompleksnogo lecheniia raka podzheludochnoi zhelezy.

The results of irradiation, combined and complex treatment of pancreatic cancer have been evaluated versus stage, site and extent of surgery. Radiotherapy was carried out in 63 patients (1988-1999): prior to gastropancreaticoduodenectomy (GPDE)--7; after GPDE--12; for local recurrence after GPDE--4, before and after left-sided resection--4, before and after conservative surgery--19, and after diagnostic verification (exploratory laparotomy or ultrasound-controlled fine-needle biopsy)--17. Diagnosis was established on the basis of clinical data and case histories, ultrasonographic, CT, histological, cytological, biopsy, blood serum-marker CA 19-9 and CEA findings. Two months after treatment, complete remission was registered in 5 (13%), partial response--5 (13%), stabilization--13 (33%), tumor progression--16 (41%). Before and after GPDE, tolerance to radiotherapy was sufficient. Median survival in this group was 12.9 months, controls--8.1 months; for conservative surgery--7.3 and 4.1 months, respectively; radiotherapy + exploratory laparotomy alone--16.8 and 4.3 months, respectively. Irradiation of locally-advanced tumors of the body and/or tail of pancreas proved effective: median survival was 7.3 months, control--2.2 months. Hence, radiotherapy made an important contribution to treatment of locally-advanced and resectable pancreatic tumors and longer survival.

[Valvular pyloroplasty in the treatment of pyloroduodenal ulcers]. / Klapannaia piloroplastika v lechenii oslozhnennykh piloroduodenal'nykh iazv.

Original method of treatment of complicated pyloroduodenal ulcers is proposed. The results of different organ-saving operations in complicated pyloroduodenal ulcers were analyzed in 136 patients aged from 15 to 89 years. Evaluation of the results was based on the data obtained during study of secretory and motor-evacuatory function of the stomach, state of gastric and duodenal mucous membrane, degree of duodenogastric reflux. Gastroscopy in remote period after organ-saving operations enabled visual evaluation of state of anew formed pyloric canal. Results of treatment of complicated pyloroduodenal ulcers by different methods of pyloroplasty demonstrate the advantages of valvular pyloroplasty.

[Prognostic factors influencing results of the surgical treatment of pancreatic cancer]. / Prognosticheskie faktory, vliiaiushchie na rezul'taty khirurgicheskogo lecheniia pri rake podzheludochnoi zhelezy.

In patients with carcinoma of the pancreas 128 gastropancreatoduodenal resections (GPDR), 15 distal resections of the pancreas and 3 pancreatectomies were performed. After GPDR 5-year survival was 12%, the survival median was 24.3 months. Only one patient is living 6 years after left-sided resection and pancreatectomy. Long-term results of the operative treatment for carcinoma of the pancreas depended on the amount of regional metastases, degree of differentiation of the tumor, its size and invasion into the vessels. The long-term results were considerably worse if the tumor was localized in the uncinate process, body and tail of the pancreas. The 5-year survival was noted mainly in patients with the 0 and I stages of the disease. It shows the early diagnostics to be necessary.

[A polymorphism study of the CYP19 gene in endometrial cancer patients]. / Izuchenie polimorfizma gena CYP19 u bol'nykh rakom éndometriia.

A strong connection is known to exist between initiation/promotion of endometrial cancer and excess of estrogens. Therefore, participation of certain alleles of genetic polymorphisms in steroid biosynthesis or metabolism may be responsible for predisposition to the disease. The present study, comparing CYP19 (aromatase) gene polymorphism in 85 patients and 110 healthy females, pointed to a more frequent occurrence of relatively longer alleles (A6 and A7) of the CYP19 gene in the former group. Furthermore, precisely those genotypes co-occurred more frequently with elevated blood levels of estradiol and testosterone in postmenopausal patients. Hence, CYP19 gene polymorphism may be regarded as a factor of genetic risk for endometrial carcinoma.

[Treatment of patients with foreign bodies in rectum]. / Lechenie bol'nykh s inorodnymi telami priamoi kishki.

The analysis of treatment results in 112 patients with foreign bodies in the rectum, aged from 16 to 80 years, was carried out. 99.1% of the patients were men. All the patients were examined and treated in proctology department of the Moscow municipal clinical hospital N 67 from 1969 to 1998. The examination was made by standard scheme, including rectal touch, rectoromanoscopy, X-ray and ultrasonic examinations. In 107 patients the foreign body was removed without surgery, 5 patients required laparotomy. When possible it was removed by fingers and also with use of forceps. When small foreign bodies could not be reached by finger, they were removed through rectoscope. Foreign bodies of big sizes, proximal end of which was in the sigmoid colon, were removed under anasthesia with the help of the assistant who fixed the foreign body through the abdominal wall in the left ileac region. In impossibility of the subject removal by these methods and presence of complications (perforation, peritonitis), laparotomy with subsequent transanal subject removal without colon section was performed, in case of perforation--with wound suturing or colostomy.

[Liver injuries]. / Povrezhdenie pecheni.

The analyses of literature data on the results of the treatment of patients with mechanical injuries of the liver have been done. Analyses of 458 cases of open and closed liver traumas made it possible to determine 2 clinical forms of liver injuries: hemorrhagic and peritoneal. The separate subforms of traumatic liver disease in isolated multiple and combined injuries are determined. A diagnostic role of various methods was evaluated. Use of laparoscopy in 17 patients has exposed a superficial character of liver injuries and allowed not to perform surgery. Use of low-frequency ultrasound and polymeric adhesive sulfacrilat for the treatment of liver wounds in 63 patients has decreased the rate of postoperative complications to 18%, and the rate of mortality in mechanical liver injuries to 11.4% (in patients with mechanical liver injuries operated on with the use of ligature-free suture).

[Treatment of lung metastasis in patients with soft-tissue sarcoma]. / Lechenie legochnykh metastazov u bol'nykh sarkomami miagkikh tkanei.

The study group included 104 patients with soft-tissue sarcoma and metastases into the lung, treated at the Institute Clinic in 1960-1992. Surgery for lung metastasis was given to 10 and chemotherapy-to 48 patients; the remaining 48 cases received treatment for symptoms only. Overall 5-year survival was 13.5% (after surgery-30.0%; chemotherapy-19.1%). All the 46 patients treated for symptoms died within two years after detection of lung metastasis. Chemotherapy proved effective in the treatment of multiple metastasis when detected shortly after removal of the first lesion.

Microvascular reconstruction of the esophagus with pedicled small intestine.

A modified procedure for total reconstruction of the esophagus with small intestinal transfer is suggested. It includes reconstruction of marginal and lymphatic vessels of its mesentery using microsurgical technique. With application of the modified procedure, the transplant may be longer, its loops may be straightened and better vascularized, and lymphatic drainage of the intestine may be preserved.

[Concentrated irradiation as a stage of multimodal treatment of cancer of the proximal part of the stomach]. / Kontsentrirovannoe obluchenie kak étap kombinirovannogo lecheniia raka proksimal'nogo otdela zheludka.

The postradiation changes in carcinoma of the proximal part of the stomach were studied in 32 patients: the parenchymal volume (PV), the damage index (DI), and the mitotic index (MI). The controls were 15 cases in which radiotherapy was not applied. Radiotherapy with large fractions (5 Gy 4 times daily) reduced the PV to 27 +/- 0.8 u on average as compared to the controls (77 +/- 1 u) and lowered the MI to 2.3 +/- 0.5% as compared to the controls (8% +/- 1), the DI ranged widely (3-67%). The methods of quantitative morphological study of tumors may be useful in objective evaluation of the efficacy of various schemes of preoperative concentrated irradiation.

[Combined surgery in cancer of the proximal section of the stomach]. / Kombinirovannye operatsii pri rake proksimal'nogo otdela zheludka.

The investigation showed combined surgery for cancer of the gastric cardia to be justified from the oncological point of view. Such intervention reaches out to the limit of radical treatment. However, combined surgery should not be performed unless there are substantial indications. Basic indications for excision or resection of an adjacent organ should be gastric tumor extension through organs and tissue or dissemination to the regional lymph nodes which cannot be radically removed unless surgery is performed on adjacent organs.