PSAMMOMA BODIES IN LYMPH NODES OF THE NECK: POSSIBLE PRECURSOR OF LOCOREGIONAL METASTASES OF PAPILLARY THYROID CARCINOMA.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common type of well-differentiated thyroid cancer accounting for up to 80% of all thyroid neoplasms. Metastases to the regional lymph nodes (RLN) of the neck are a feature of its biological aggressiveness. The presence of psammoma bodies may be considered a pathomorphological feature of PTC in addition to the papillary structure of tumor and specific nuclear changes. The aim of the study was to evaluate a clinical value of psammoma bodies in the RLN of PTC patients. MATERIALS AND METHODS: 91 patients with PTC who were surgically treated at the Verum Expert Clinic were enrolled in the study. The clinical and pathomorphological data were retrieved from the archival medical records. RESULTS: According to the results of the clinico-morphological analysis, 51 patients (56%) with PTC had metastases in the RLN of the neck, and 40 (44%) patients had no metastases. Among 51 patients with metastases in the RLN, in 4 patients psammoma bodies in the RLN and tumor tissue were identified. In 3 of these 4 patients, the size of the primary PTC tumor was less than 10 mm, but an aggressive cancer course such as significant number of metastases in the RLN or multifocal growth was found in all these cases. CONCLUSIONS: The presence of psammoma bodies in RLN and primary PTC tumor could be suggested as a predictor of metastasis to lymph nodes. The detection of point echogenic foci in the lymph nodes by ultrasound at the preoperative stage is a sign of psammoma bodies. This finding can be useful for improving the efficacy in selection of surgical treatment tactics for the optimal neck dissection by planning neck dissection in the presence of such point echogenic foci at the preoperative stage and performing regular check-ups of the patients.

APPLICATION OF ARTIFICIAL INTELLIGENCE IN CIVIL AND MILITARY MEDICINE.

Artificial intelligence (AI) encompasses the advancement of computers and robots, enabling them to surpass human capabilities in various aspects. By utilizing AI, programs have the ability to autonomously analyze and interpret data, offering information and executing actions without any human involvement. The ongoing war in Ukraine showed various aspects of severe gunshot injuries because of previously unknown course of wounds after application of ballistic missiles, drones, etc., which is frequently applied by russians. In such conditions, decision-making process by military medical doctors must be quick and rational, however in case of massive casualties, combined trauma (e.g. thoracoabdominal gunshot injury) MDs might have permanent challenges to apply appropriate care options and individualized approach. The aim of this study is to start the discussion about role and possible application of AI in management of gunshot injuries in combat patients or other individuals who received wounds relating to high-energy weapon. Conclusions. Gunshot wound is a clinical challenge in many cases among patients who were injured by high-energy weapons, requiring complex and quick decisions. AI might be applied as an additional tool for the decision-making process in case of severe trauma in deployed field hospitals, or in hospitals of higher Roles (3-4). This study is to start the research discussion about the utility of AI application for the management of the injured in the war associated with high-energy weapons.

MILESTONES AND PITFALLS IN STRATEGIC PLANNING OF HEALTHCARE IN CAPITAL CITY IN TRANSITION.

A little is known about healthcare sector within Strategic plan of Kyiv, which is capital of Ukraine and a city in transition. The aim of this study was to investigate and evaluate implementation of strategic plan for Kyiv with the focus on healthcare sector. There were evaluated Strategic plan for Kyiv, Concept for healthcare development from the Department of Healthcare, City's target program "Health of Kyivers". Data analyses showed 13 (45%) out of 29 strategic initiatives were not implemented for healthcare sector. Data from statistical analyses indicated that low performance from Department of Healthcare was similar for all operational goals. Our findings demonstrated low implementation rate of strategic initiatives within the healthcare sector of city's Strategic plan. Possible causes of low strategic performance could be due to weak institutional relations between top and low executive levels, as well as inconsistency in strategic documents, stuff turnover.

[Analysis of efficacy of complex treatment of patients with differentiated forms of the thyroid gland cancer using distant radiation therapy]. / Analiz éffektivnosti kompleksnogo lecheniia bol'nykh s differentsirovannymi formami raka shchitovidnoi zhelezy s ispol'zovaniem distantsionnoi luchevoi terapii.

Retrospective analysis of efficacy of complex treatment, including surgical intervention, radioiodine therapy (RITH), suppressive hormonotherapy of differentiated forms of the thyroid gland cancer (DFTHGC) was done in 281 patients with positive effect of postoperative distant radiation therapy (PDRTH) application as a component of the treatment. Positive effect of therapy was estimated basing on the dynamic scintigraphy data with 131I and determination of thyroglobulin level in blood serum. The PDRTH conduction does not improve prognosis of the disease, does not lower the tumor metastasizing frequency to regional lymph nodes and remote organs and does not replace RITH. To achieve positive result in 12.8% of patients with PDRTH more than two courses of RITH were performed, enhancing so the total radiation dosage on the organism. To provide protracted nonrecurrent survival of patients with DFTHGC the radical approach is necessary, envisaging performance of thyroidectomy, the timely conduction of RITH with subsequent suppressive therapy using L-thyroxin.

[Treatment and monitoring of patients with differentiated cancer of thyroid gland]. / Lechenie i monitoring bol'nykh s differentsirovannym rakom shchitovidnoi zhelezy.

There were examined 200 patients aged from 19 to 77 years with differentiated cancer of the thyroid gland (TG). The combined treatment, which included performance of operation, radioiodine therapy and hormonotherapy, was conducted to all the patients. Total and maximum subtotal TG resection was performed in 90% patients, nonradical operation--in 10%, 23% patients were reoperated. Postoperative monitoring according to chart was done with application of dynamic scintigraphy and determination of the thyroglobuline level in the blood serum. The TG residual tissue (RT) was revealed in 61% patients and in 39%--the cancer metastases in the lymphatic nodes. RT of TG was eliminated in 86.8% patients after the first radioiodine therapy course conduction in middle remedial activity (2.79 +/- 0.11) GBq, the metastases devitalization--in 67.9% in middle remedial activity (4.07 +/- 0.12) GBq.