[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

[Use of 'Korona' cava filter in oncological patients]. / Primenenie kava-fil'tra 'Korona' u onkologicheskikh bol'nykh.

Using the 'Korona' cava filter in a total of 1345 oncological patients revealed regularity of a change in the shape of the inferior vena cava at the level of implantation. This made it feasible to determine one of the causes of long-term complications following implantation of other models of cava filters. The absence of clinically significant complications in the remote period after using this model of cava filter made it possible to implant it for a longer period, which is of special importance in oncological patients.

[New minimally invasive methods for internal bile outflow in oncology].

A few novel minimally invasive techniques are described for catheter-free repair of internal bile outflow in patients with neoplasms in the biliopancreatoduodenal region complicated by mechanical jaundice and in cases of iatrogenic complications of surgical treatment. The methods based on a combination of modern interventional radiologic and endoscopic technologies allow to improve the outcome of antineoplastic treatment and the quality of life in certain categories of patients. The introduction of these techniques into clinical practice of specialized medical facilities may help to optimize the treatment strategy, reduce the volume of surgery whenever it can be confined to minimally invasive treatment, decrease the employment index, increase the surgical bed turnover rate and other economic characteristics of a surgical clinic.

Case Report: Education and training of RTTs for radiation oncology departments in Russia.

Modern radiotherapy is performed with sophisticated equipment that requires highly qualified professionals. In the Russian Federation the responsibilities of Radiation Therapy Technologists (RTTs) are carried out by medical nurses who receive on-the-job training. The article discusses the problems of RTT education and training, describes our own teaching experience and suggests further development for the national RTT education system in Russia.

[High technologies in radiodiagnostics: possibilities and prospects].

Diagnostic radiology includes several basic techniques such as conventional radiography, computed tomography, magnetic resonance imaging, radionuclide study, ultrasonography, and positron emission tomography as the most important methods. Radiological screening procedures or preclinical diagnostic techniques, as well as interventional radiological procedures, are being used more and more widely in clinical medicine. The integration and combination of different technologies, the introduction of digital diagnostic technologies, and the creation of radiological information systems on their basis are important factors increasing diagnostic efficiency. Improved technologies make it possible to change diagnostic tactics in the majority of diseases; the diagnostic process shortens because preference is given to most informative methods. Intensive technological development requires changes in the arrangement of radiologists' work.

Perfusion CT and PET with 18F-FDG and 18F-FCh in the complex diagnosis of hepatocellular carcinoma.

BACKGROUND: The purpose of the study to evaluate possibilities of CT-perfusion and PET methods with 18F-FDG and 18F-fluorocholine in the complex diagnosis of hepatocellular carcinoma. The study included the results of PET/CT with 18F-FDG, 18F-FCh and CT-perfusion of the liver in 18 patients with histologically confirmed diagnosis of hepatocellular carcinoma (HCC). Depending on the degree of tumor differentiation, all patients were divided into 3 groups - patients with highly differentiated (6 patients), moderately differentiated (4 patients), and low-differentiated HCC (8 patients). RESULTS: Average values of maxSUV in the group of patients with highly differentiated HCC in PET/CT with 18F-FDG and 18F- fluorocholine in a solid component of tumor reached 3.51 and 18.24, respectively; in patients with moderately differentiated HCC - 3.91 and 12.32, respectively; in patients with low-differentiated HCC - 9.58 and 9.70, respectively. Average values of CT perfusion imaging in a solid component of the tumor in the group of patients with highly differentiated HCC were the following: BF - 55,33 ml/100 ml/min, BV - 13,71 ml/100 ml, ALP - 52,41 ml/100 ml/min, PVP - 10.81 ml/100 ml/min (p ≤ 0,05), in the group of patients with moderately differentiated HCC: BF - 52,78 ml/100 m /min, BV - 12,23 ml/100 ml, ALP - 47,26 ml/100 ml/min, PVP - 9,10 ml/100 ml/min (p ≤ 0.05), in the solid component of low-differentiated HCC: BF - 46,96 ml/100 ml/min, BV - 9,49 ml/100 ml, ALP - 40.54 ml/100 ml/min, PVP - 7,66 ml/100 ml/min (p ≤ 0,05). CONCLUSIONS: The diagnostic capabilities of the complex of PET/CT techniques with 18F-FDG and 18F-FCh and CT perfusion in a single-scan mode for hepatocellular carcinoma were evaluated for the first time. The obtained data allow to assume that the integrated use of PET with 18F-FDG and 18F-FCh and CT perfusion in a single scan improves the differential diagnostic possibilities of PET/CT diagnostics, which can find application in planning and prognosis of the disease. Due to the small number of patients further study of the problem is required.

NEW DIRECTIONS FOR IMPROVEMENT OF BREAST CANCER SCREENING.

Objective: to improve breast cancer diagnosis using an independent mammographic teleassessment by two radiologists. Material and methods. The results of a dual independent assessment of 3440 X-ray mammographic examinations were analyzed. The first assessment was made by a radiologist from a therapeutic-and-prophylactic establishment who had less than one year of practical experience in a mammography screening room. The second assessment was carried out by a radiologist with more than 5 years of experience from a specialized cancer institution. Results. According to the developed specialized interpretation software, recommendations and statistics for mammographic breast cancer screening, the investigators identified a group of 31 women who were recommended to be additionally examined at an oncology dispensary to verify the diagnosis of breast cancer. Eight of 17 (47%) women with morphologically confirmed cancers after dual assessments of X-ray mammographs were called again and referred to the oncology dispensary. Conclusion. Dual independent assessment of X-ray mammographs improved the diagnosis of BC with a maximum size of 1.5 cm or less, as well as that of malignant tumors manifesting as microcalcifications or imitating a benign process.

[Radiation diagnosis of malignant neoplasms at the current stage]. / Luchevaia diagnostika zlokachestvennykh opukholei na sovremennom étape.

The paper presents all currently available oncological radiation diagnostic tools as compared to the well-known ones. It discusses different methods of obtaining images depending on their physical features: digital plain radiography, computed tomography, magnetic resonance imaging, bone scintigraphy, positron emission tomography, radioimmunoassay, ultrasonography (by using Doppler, intraoperative ultrasound, laparoscopy and thoracoscopy ultrasound, endoscopy ultrasound, contrast-medium ultrasound). The feasibilities of interventional radiology in malignancies are more precisely defined. There are prospects for developing different radiology techniques with the advent of high-performance computer technologies that make it possible to set up a digital radiology unit. The developed PACS system of data reception, keeping, and transmission will accumulate and keep images during unlimited time, transmit them at any distances, process them in different 3 ways, modify and improve, make paper and film hard disks at any time.

[Percutaneous transhepatic x-ray endobiliary interventions in the complex diagnosis of cancer of the hepatopancreatoduodenal area complicated by mechanical jaundice]. / Chreskozhnye chrespechenochnnye rentgenoéndobiliarnye vmeshatel'sva v kompleksnoi diagnostike raka gepatopankreatoduodenal'noi zony, oslozhnennogo mekhanicheskoi zheltukhoi.

58 patients with hepatopancreatoduodenal cancer complicated by mechanical jaundice underwent complex examination including X-ray computed tomography, angiography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic roentgenoendobiliary procedures and puncture biopsy. The diagnostic value of each procedure was assessed, implementation of 6 conventional diagnostic tasks serving as a criterion. The procedure suggested allows to individualize diagnostic work-up to assure maximum reliability. Percutaneous transhepatic roentgenoendobiliary methods are considered a complex of diagnostic and therapeutic manipulations.

[Evaluation of the effectiveness of preoperative polychemotherapy of nephroblastomas in children by angiography, ultrasonic tomography and computed tomography]. / Otsenka éffektivnosti predoperatsionnoi polikhimoterapii nefroblastom u detei metodami angiografii, ul'trazvukovoi i komp'iuternoi tomografii.

The results of preoperative polychemotherapy of nephroblastoma in 14 children are presented. Ultrasonic tomography, computed tomography and angiography were performed in all the patients before and after medication. The findings on the efficacy of polychemotherapy were assessed on the basis of surgical evidence and, in particular, resected material examination. A high diagnostic value of all the methods was demonstrated and criteria of the effectiveness of preoperative polychemotherapy as evaluated by application of ultrasonic and computed tomography and angiography were worked out. Optimal terms of carrying out diagnostic procedures in patients with nephroblastoma during preoperative treatment are suggested.

[Ways of improving results of gastro-pancreatoduodenal resection in tumors of the bilio-pancreatoduodenal area]. / Puti uluchsheniia rezul'tatov gastropankreatoduodenal'nykh rezektsii po povodu opukholei biliopankreatoduodenal'noi zony.

The results of treatment of 86 patients who had been subjected to gastro-pancreatoduodenal resection in the period from 1975 to 1992 were studied. The patients were divided into two groups. The main cause of postoperative mortality in the first group was the development of pancreonecrosis and incompetence of the pancreatico-enteral anastomosis. Hypothermia of the pancreatic duct and introduction of 5-fluorouracil into the pancreatic duct reduced postoperative mortality among patients of the second group from 34.9% to 13.9%. It is shown that this method may be applied in wide surgical practice.

[Rare tumors and nontumorous lesions of the neck (angiographic and computed tomographic studies)]. / Redkie opukholi i neopukholevye porazheniia shei (angiograficheskie i komp'iuterno-tomograficheskie issledovaniia).

The authors analyze the findings of carotid arteriography and X-ray computer-aided tomography in rare tumorous and pseudotumorous involvement of the blood and lymph systems of the neck, namely, in hemangiomas, lymphangiomas, angiofollicular lymphomas, angioleiomyoma, carotid artery aneurysm. Specific features of roentgenosemeiotics and problems of a differential diagnosis are discussed.

[Antitumor antibiotics in the treatment of nephroblastomas in children]. / Protivoopukholevye antibiotiki v lechenii nefroblastom u detei.

The results of the chemotherapy of 20 children with nephroblastoma are analysed. The patients were treated according to the following scheme: vincristine in a dose of 0.05 mg kg bw once a week on the 1st, 8th, 15th and 22nd days, dactinomycin in a dose of 15 micrograms/kg once a day for 3 days on the 1st, 2nd and 3rd days of adriamycin in a dose of 30-40 mg/m2 on the 15th day of the treatment course. The postoperative chemotherapy was started 10 days after the operation. It was performed in 4 courses with intervals of 3 weeks. The efficacy of the treatment was estimated with angiography, echography and computer-aided tomography. The above scheme proved to be efficient in the treatment of the children with nephroblastoma. Reliable control of the tumor size during the preoperative treatment was shown to be possible.