[SURGICAL TREATMENT OF PATIENTS FOR METACHRONOUS METASTASES OF PULMONARY OSTEOSARCOMA. CLINICAL PROGNOSTIC FACTORS].

The impact of surgical method on results of complex treatment in patients, suffering the osteosarcoma metachronous pulmonary metastases, was studied. The survival indices in 93 patients were analyzed, of them in 71, suffering osteosarcoma - with complex treatment, including surgical intervention of complete excision of all metastases (three-years survival ­ 34.2%), and in 21 ­ complex treatment with palliative radiation therapy (three-year survival 3.7%). Trustworthy impact on three-years survival indices was proved for such clinical factors, as the terms of the metastases occurrence (6 mo and lesser, and more, than 6 mo) and quantity of metastases (up to 5, 5 and more) present.

[THE PATIENTS QUALITY OF LIFE ESTlMATION IN PRESENCE OF METASTASIS OF A RENAL-CELL CANCER IN THE BONES ON BACKGROUND OF THE BISPHOSPHONATES APPLICATION].

Results of the patients quality of life (QL) estimation, while presence of a renal-cell cancer metastasis in the bones, using questionnaire QLQ-C30 and Karnofsky index, as well as the pain visual-analogue scale on background of treatment with bisphosphonates (BPH), were adduced. After conclusion of the combined treatment the general state improvement, a trustworthy reduction of the pain syndrome severity, as well as the patients' psychoemotional and social state, were noted. Complex treatment of patients, using BPH, have promoted a positive impact on their QL as well as a reduction of a skeleton complications rate.

[TARTRAT-RESISTANT ACID PHOSPHATASE AS BONE'S RESORBTION MARKER IN PATIENTS WITH BONE METASTASES].

Determination of serum markets of bone resorption in patients, with renal cancer after radical surgery can improve the accuracy of early diagnosis of bone metastases, assess the extent of metastatic bone lesions, and monitoring of bisphosphonates treatment. These data suggest promising activity for tartrat-resistant acid phosphatase (TRAP-5b) of early detection of bone metastasis.

[PREVENTION OF THE BONES METASTASES OCCURRENCE IN THE PATIENTS WITH RENAL-CELL CANCER].

Diagnostic significance of estimation of the tartratresistent acid phosphatase (bone TRAP--5b) activity was studied for prognosis of occurrence of metastases in bones (MB) in patients with a renal-cell cancer (RCC). The risk of the MB occurrence was determined in patients after surgical treatment. A skeleton affection rate in patients, to whom zolendronic acid was prescribed, was trustworthy bigger, than such while conduction of treatment. So, application of bisphosphonates is recommended, in particular--zolendronic acid in dosage 4 mg every month under control of the bone TRAP--5b activity with objective of prophylaxis of the MB occurrence in patients, suffering RCC. But, we recommend for the MB diagnosis the method of determination of this marker activity as additional one while examining patients together with standard methods, including osteoscintigraphy, computer tomography.

[Reconstructive interventions on the hip joint for tumors of proximal part of the femur].

In 41 patients with proximal femur tumors there were studied clinical results of performance of various reconstructive interventions on a hip joint. It was established, that the hip joint endoprosthesis using the cement two-polar total prosthesis had secured the lower extremity function restoration on the level of (84.6 +/- 2.2)%, in arthrodesis--the lower extremity function had restored up to (52.3 +/- 0.5)%. After endoprosthesis an early (in 30% of observations) and late (in 20%) complications had occurred, in arthrodesis the complications were absent.

[Treatment outcome of patients with bone tumors after limb salvage surgery].

In 336 patients with various tumors of the limb bones underwent limb sparing surgery with different kind of reconstructions. The oncological results of the treatment of these patients have been analysed. Local relapse after limb sparing interventions because of extremities bone tumors developed in 4,17% of all cases. In most cases, local recurrences have been observed in patients with bone sarcomas high degree of malignancy (7,14%) and low degree of malignancy (2,82%). In 57,1% of cases, local recurrences developed in patients with osteogenic sarcoma IIB stage. The appearance of local recurrence was a bad prognostic factor for patients with bone sarcomas high grade, because it reduced 5-year survival rate almost 2 times. The overall 5-year survival of patients with bone sarcomas high grade of malignancy were (59,67 +/- 5,69)%, and 5-year relapse-free survival rate--(55,23 +/- 5,52)%. Local recurrences more often developed after the use of distraction method of surgery--in 16% of all reconstructive operations, including 12% of the cases with bone tumors of high degree of malignancy, which should be considered when choosing this method of reconstruction.

[The treatment of infectious complications after endoprosthesis of the joints in patients with oncological diseases of joints and bones].

Infectious complications after endoprosthesis of the main joints, performed for tumors of the bones, are registered in 9.5% of observations. These complications occur more frequently in patients, to whom the conduction of supportive antitumoral therapy is indicated. Algorhythm, including the staged performance of conservative and surgical interventions, was elaborated for treatment of such complications. Conservative measures had included active draining of the wound, systemic and local antibacterial therapy, and while applying the surgical treatment--using of spacers and other methods of reconstruction (dystractional and bone-plasty one). Application of such algorhythm have permitted to achieve successful treatment of infectious complication, preserving functioning extremity in 66.7% of cases.

[Results of pamidron acid application in prevention of instability of bones implants].

The influence of "Pamired" bisphosphonatic group medication on bone resorption in the area of endoprosthesis leg contact with a bone have been studied. 14 patients who underwent endoprosthesis of different joints because of bone tumors have been observed. The conclusion was made about the possibility of "Pamired" medication use for the prophylaxis of the development of aseptic shaking loose of implant legs after endoprosthesis made because of bone tumors.

[The elbow joint prosthesis in tumors of the forming bones].

There were proposed the modified method of surgical intervention on the elbow joint for tumors of the bones, which form it, and for the elbow joint endoprosthesis--the implant of original construction. Application of the implant elaborated in 8 patients have permitted to restore the upper extremity function practically completely.

[Use of local magnitothermia in the treatment of patients with primary-confined skin melanoma]. / Opyt primeneniia lokal'noi magnitotermii pri lechenii bol'nykh s pervichno-ogranichennoi melanomoi kozhi.

We studied modifying potentialities of high temperatures in treatment regimens with adjuvant endolymphatic chemo- and interferontherapy of malignant melanoma of the skin. We had previously obtained enough evidence for expediency of adjuvant endolymphatic therapy of primary-localized melanoblastoma of the skin. Added to the preventive treatment regimens were sessions of local magnetothermia. The study was done in patients diagnosed as having primary-localized melanoma of the skin T(2-4) No Mo. A 3-year recurrence-free survival in the control group was (38.2 +/- 1.6)%, in the first study group--(54.2 +/- 5.8)%, in the second study group--(44.3 +/- 13.5)%. The general 3-year survival in the control group was (67.7 +/- 1.5)%, in the first study group--(70.8 +/- 5.5)%, in the second one--(91.7 +/- 5.7)%. In this way, the expediency has been proved of employment of local magnetothermia in treatment regimens to deal with malignant melanoma of the skin.