Leiomyosarcoma of soft tissues. Clinical characteristic and results of treatment.

Clinical characteristics of leiomyosarcoma of soft tissues and results of treatment of patients with this pathology are presented. It was revealed that the peak of incidence was in the age group 5O-69 years. There was showed the priority of surgery, as the only method of treatment, and in the combined regimen with the overall five-year survival of 43,2% and 33,3% respectively.

[Pharmacokinetics of fentanyl during sevoflurane based general anesthesia in children].

The research is based on the analysis of 50 cases of anesthesia during reconstructive surgeries in children. The anesthesia was based on inhalation of sevolflurane and injection of fentanyl by the bolus infusion scheme. During the different stages of anesthesia the opioid concentration in plasma was measured. Analysis of hemodynamic parameters showed no statistically significant differences in changes in performance, indicating the steady flow of anesthesia. Infusion of fentanyl provided a smooth, gradual decrease in its concentration in plasma, while analgesia remained adequate. The combination of sevoflurane in a concentration of 1.3 MAC and infusion of fentanyl to a total dose 6 mkg/kg/h was effective in provisioning stable anesthesia in the given category of patients with surgical pathology.

[Role of palliative surgery in complex treatment for disseminated breast cancer].

An assessment was undertaken of survival and prognosis in 30 patients with primary disseminated breast tumors which disintegrated following palliative mastectomy carried out for sanitary purposes. That resulted in significant improvement in general condition, higher hemoglobulin and lowered intoxication which in turn made medication and radiotherapy possible: chemotherapy (4-6 cycles) followed by hormonal therapy (22-73.3%), hormonal therapy (8-26.7%), and radiotherapy for surgical scar (16-53.3%). All patients were followed up for 18 months (median--3.8 years). Tumor progression at different stages was detected in 12 (40%); local recurrences--8 out of them (26.7%). By the time of investigation, 9 (20%) out of 30, had died of tumor progression while 21 (80%) continued their treatment at the Institute's Clinic. Mean survival was 21.5 +/-2.2 months (median--19 (8-60+)). Our method proved effective due to high survival (median--18 months) and significant improvement in quality of life. However, visceral metastases (p = 0.02) and tumor growth duration (p = 0.05) were of prognostic significance. Such characteristics as presence or absence of estrogen and progesterone receptors of tumor, histological pattern, and anemia appeared insignificant, as far as prognosis was concerned. Function chi2 difference was highly significant (Cox) (p = 0.00013).

[Effect of volatile inhalational anesthetics on cerebral blood volume and oxygen status in children].

The investigation evaluated the effect of various volatile anesthetics on cerebral blood volume and oxygen status in sick children at the stage of anesthesia induction. Ninety-two children were distributed into 3 groups: Groups 1 (n = 36) and 2 (n = 24) underwent stepwise induction with halothane and enflurane, respectively. Group 3 (n = 32) had vital capacity rapid inhalation induction with sevoflurane. Cerebral oximetry (NIRS method) was used to measure the content of hydroxyhemoglobin, deoxyhemoglobin, the total level of hemoglobin and to assess regional cerebral tissue saturation (rSO2). Halothane was ascertained to increase cerebral blood volume by 20.5% whereas enflurane and sevoflurane increased it only by 8.8 and 9.0%, respectively. In all cases, the value of rSO2 remained comparatively high, by exceeding the baseline level by 3-5%.

[Central and cerebral hemodynamics during gynecological laparoscopic interventions in children].

The authors examined central and cerebral hemodynamics in children during gynecological laparoscopic interventions. The course of 64 anesthesias was analyzed in girls aged 3 to 16 years, who had undergone laparoscopic surgery. Central hemodynamics was studied by tetrapolar rheography on a Diamant apparatus; cerebral oximetry was examined on a Critikon RedOx Monitor 2020 device. The findings demonstrate that pneumoperitoneum application causes immediate cardiovascular changes. Transfer of patients to Trendelenburg's position had a beneficial impact on central hemodynamics, by facilitating the normalization of venous return, thus maintaining cardiac output. Central hemodynamic disorders promptly affected cerebral blood volume and oxygen status. After pneumoperitoneum application, there was an average of 3% reduction in regional cerebral tissue saturation.