[Hepatic leiomyosarcoma: a case report].

The authors present a review of pathogenesis, diagnosis and various approaches to treatment for an extremely rare tumor - primary hepatic leiomyosarcoma. This tumor is dif- ficult to be diagnosed by imaging examinations. The prevalent method of treatment is a radical resection (RO surgery). Ac- cording to literature the median survival of patients with LMSL is about one year with DFS after treatment about 10 months. Also the authors describe a case report of the successful cure of middle-aged female with primary hepatic leiomyosarcoma and Hodgkin's lymphoma in the anamnesis. She has undergone 6 cycles of neoadjuvant chemotherapy with Ifosfamide and Doxorubicin. The tumour response was estimated as partial. Then patient has undergone radical surgery in the volume of extended left hemihepatectomy with LND. Follow-up exami- nation 38 months after treatment revealed no progression of the disease.

[MODERN APPROACHES TO PERIOPERATIVE THERAPY FOR LUNG CANCER: "PRO" AND "CONTRA" FROM THE PERSPECTIVE OF EVIDENCE-BASED MEDICINE].

Patients with resectable non-small cell lung cancer have a chance to reach a 5-year survival rates ranging from 70% or more for stage IA and 20% for stage IIIA. These figures have remained stable for the past 20 years. Moreover, the inability to improve long-term outcomes is generally determined by a fatal disease progression due to the emergence of distant metastases or local recurrence often in combination with systemic progression process. Thus the use of chemotherapy both in neoadjuvant and adjuvant regimens has stimulated for a long time the search for the optimal scheme and treatment options. This article presents a critical analysis of the current state of the problem of neoadjuvant and adjuvant chemotherapy as well as chemoradiotherapy in order to optimize the tactics of combined treatment of these groups of patients.

Antibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review).

Controlling infection is crucial in treating patients with acute pancreatitis (AP). The infectious process in AP often predisposes to subsequent sepsis by damaging not only the pancreas, but retroperitoneal tissues as well. Among other AP-associated factors, are the rapidly developing immune imbalance, the poor penetration of antimicrobial agents into necrotic tissue, and the impossibility of a single surgical debridement. Antibacterial and antifungal therapy for patients with infected necrosis and AP-associated extra-pancreatic infections remains a complex and largely unresolved problem, partially due to the high occurrence of multiresistant pathogens. The preventive use of antimicrobial agents has been discussed in the literature; however, the lack of consistent results makes it difficult to develop a unified strategy and clinical guidelines on this specific issue. Recent meta-analyses provide no conclusive evidence that antibacterial prophylaxis reduces the infection rate, mortality, or the need for surgical treatment in patients with necrotizing pancreatitis. We found only two studies indicating the benefits of using carbapenems for prophylactic purposes and one meta-analysis indicating a reduction in mortality under antibiotic treatment started no later than 72 h after the onset of the attack. Selective bowel decontamination is considered as one of the preventive anti-infection measures, although the available data may not be fully reliable. The main indications for antibacterial therapy in patients with AP are confirmed infected necrosis or extra-pancreatic infection, as well as clinical symptoms of suspected infection. Intra-arterial administration or local treatment with antibiotics can increase the efficacy of antibacterial therapy. No randomized studies on antifungal prophylaxis in AP are available; some reports though recommend using such therapy among patients at high risk of invasive candidiasis.

[Internal drainage of the bile ducts in acute cholecystitis]. / Vnutrennee drenirovanie zhelchevyvodiashchikh putei pri ostrom kholetsistite.

An experience with the treatment of 286 patients with acute cholecystitis is described. Cholecystectomy was performed in combination with one of the methods of internal drainage of bile ducts which made up 33.1% of the total number of operations performed for acute cholecystitis. Lethality in this group of patients was 4%. To decrease the amount of postoperative complications and lethality the external drainage of bile eliminating ducts is indicated in the nearest postoperative period.

[Gastrectomy in the treatment of gastric hemorrhage]. / Gastréktomiia v lechenii zheludochnykh krovotechenii.

The results of gastrectomies performed in 7 women and 13 men (aged from 41 to 73) with various diseases of the stomach (cancer, non-epithelial tumors, erosive and ulcerous gastritis, ulcer and phlegmonous gastritis) are analyzed. The surgical interventions included operations from gastrectomy to gastropancreatosplenoduodenocholecystectomy with phleboplasty of the portal vein and extended parietal lymphadenectomy. Ten operations were made for profuse bleedings with 4 fatal outcomes. During the first 48 hours after the appearance of the complication 10 patients were operated upon for the recurrence of the risk of recurrent hemorrhage. The formation of muff-like variants of esophagojejunostomy was preferred. The results are considered to be promising.

[Trans-duodenal interventions in acute cholecystitis]. / Transduodenal'nye vmeshatel'stva pri ostrom kholetsistite.

110 transduodenal interventions were performed on patients with acute cholecystitis complicated by choledocholithiasis and stenosis of the major duodenal papilla in 1981-85. Mechanical jaundice was diagnosed in 51 of them. Most of the patients were operated upon in the "cold" period. Papillosphincteroplasty was performed on 73 patients, papillosphincterotomy--on 17, transduodenal ++supra-papillary choledochoduodenoanastomosis--on 20 patients. A special probe was used during operation for the detection and dissection of the major duodenal papilla. Lethality after operation was 2.7%.

[Suppurative-septic complications after surgical treatment of destructive pancreatitis]. / Gnoino-septicheskie oslozhneniia pri khirurgicheskom lechenii destruktivnogo pankreatita.

Complex prophylactics of pyo-septic complications was used in 46 patients with acute destructive pancreatitis. It resulted in 11% less frequency of the complications, postoperative lethality became 28% lower. In 35 patients with the preserved spleen resection of the pancreas was followed by less lethality as compared with similar operations including splenectomy. The immune stimulating therapy in combination with antibiotics ++ is most effective after radical operations on the pancreas.