Surgical and combined treatment of patients with Klatzkin's tumor.

Surgery as being a preferential method of treatment of patients with cholangiocarcinoma is associated with high complications and mortality levels while demonstrating poor long-term outcomes. Optimization of preoperative management and improvement of the results of surgical treatment for patients with proximal extrahepatic bile duct carcinoma. From January 1998 to December 2013 surgical treatment was performed in 36 patients (19 males, 17 females) with Klatzkin's tumor, from whom 10 patients obtained postoperative chemotherapy. Bismuth-Corlette type III-IV tumor stage was determined in 30 (83.3%) patients. Portal vein resection was performed in 13 (36.1%) patients. 27 (75.5%) patients underwent R0 resection. Postoperative mortality rate consisted 16.7%, complications were revealed in 87.1% of cases. 6 (16.7%) patients required additional surgery and interventional procedures were performed in other 20 (55.5%) patients to fix postoperative complications. Overall 5-year survival rate in R0-resection group was 40.1%, median - 29 months. In postoperative chemotherapy group overall 3-year survival rate was 66.7% which was twice higher than in surgery group but the difference was not statistically significant (p=0.35). The improvement of short-term outcomes of surgical treatment for patients with Klatzkin's tumor requires optimization of preoperative management and detailed adherence of surgical techniques. Combination of surgery with postoperative chemotherapy showed the trend to improvement of overall survival.

[The first experience of application of standardized genotype technique of identification of HIV-tropism].

The antagonists of co-receptor CCR5 are an ultimately new class of preparations to treat HIV-infection. The mechanism of action of the preparations of this class is in the selective binding with co-receptor CCR5. This process results in the prevention of penetration of HIV into cell. Before prescribing the CCR5 antagonists the detection of viral tropism has to be done. Recently, in Russia the genotype technique of tropism detection was registered which can be used in clinical practice. The present article describes first experience of application of the given technique to clinical samples. The high correlation was established while comparing with the results of reference laboratory.

[Results of the repeated hepatic surgery on the reason of malignant tumors].

The work is based on an analysis of 95 clinical observations of patients with primary and metastatic liver disease who were in the surgical department of tumors of the liver and pancreas of the State Research Institute named by N.N. Blokhin of RAMS from 1990 to 2011. All patients underwent two or more liver resections. Of all 95 patients included in this study, 64 underwent repeated interventions over a liver colorectal metastases. 10 patients had the operations, which were performed for primary hepatocellular carcinoma of the liver. In 21 patients re-resection were performed for metastatic lesions of other tumor nosology. Postoperative mortality in tumor lesions of the liver in patients who underwent repeat resection was 1.05%, postoperative complications occurred in 38.9% of patients. All patients with colorectal liver metastases who underwent repeat resection of various sizes, five-year survival rate was 53.3±8.8%. Median 35.9 months. The low level of mortality and acceptable level of postoperative complications in patients re-operated liver tumor, as well as high rates of long survival confirm the thesis about the need for such interventions as part of combined treatment of this difficult group of patients.

[Surgical treatment of hepatocellular carcinoma].

Experience of surgical treatment of 171 patients, suffering hepatocellular carcinoma (HCC), was summarized. Extensive hepatic operations were performed in 99 (71.2%) patients, of them in 22.2%--on the concurrent hepatic cirrhosis background. Late results of treatment, depending on the main prognostic factors present, were analyzed. Cumulative survival in the terms of 5, 10 and 20 years have constituted 53.5, 37.3 and 28.8% accordingly. Accomplishment of a radical hepatic resection for HCC permits to achieve a durable remission of a tumoral process. While revealing a concurrent hepatic cirrhosis stage B (according to Child--Pugh classification) it is appropriate to use a hepatic transplantation and other methods of treatment, including chemoembolization, radiofrequency ablation, chemotherapy.

[Surgical and combined treatment of patients with metastatic liver and lymph nodes invasion by colorectal cancer].

527 patients were operated on for liver colorectal cancer metastases. Of all cases of lymphadenectomy during liver resections, lymph nodes invasion was morphologically proved in 43 patients. 3- and 5-year survival rate in this group was 12,8+/-6.6% and 6.4+/-5.6%, respectively. No patients survived a ten-year interval. Maximal follow-up period was 62 months, median - 17 months. 3-year disease-free survival rate was 5.1+/-4.8%. No 5-year disease-free survival was registered. Inclusion of oxaliplatin in adjuvant chemotherapy regimen allowed the dramatical improvement of survival rates.

[The combined treatment of colorectal cancer with liver metastases].

The direct and follow-up results of surgical and combined treatment of colorectal cancer with liver metastases are presented. Complication rate after liver resections was 28.4% and lethality was 3.5%. Follow-up results evidence the decrease of survival in patients with adjuvant chemotherapy after surgery. The safety of oxalyplatin in patients after liver resections, including its intraarterial infusion through the hepatic artery is shown. Oxalyplatin-based chemotherapy regimen tended to be more effective in comparison with 5-fluorouracil scheme, especially in patients with synchronous or multiple liver metastases. Considering that the difference is not statistically significant, further studies of oxalyplatin influence on survival of patients with colorectal liver metastases are necessary.

[Stages in the improvement of drug therapy at a polyclinic]. / Etapy sovershenstvovaniia medikamentoznoi terapii v usloviiakh polikliniki.

Within 1968-1997 the authors studied the steps of introduction of the achievements of the medical science, technology and pharmacology to therapy of exacerbations and complications of peptic ulcer (PU). The scientific and practical value of endoscopic, histological, biochemical and bacteriological examinations in the improvement of the methods of pharmacotherapy of exacerbations and complications of PU was shown. Three phases of the PU development were indicated by the clinical signs and results of esophagogastroduodenoscopy, target biopsy and histological examinations. These data and available scientific achievements were assumed as a basis for the design of optimal drug combinations and their introduction to the medical practice. The use of such combinations made it possible to prevent relapses and life-threatening complications of the disease in the overwhelming majority of the patients. The best results of the pharmacotherapy were recorded in the years (1988-1997) when the drug combinations began to be used. The combinations provided eradication of Helicobacter pylori in the gastroduodenal mucosa and it was proved that in all the patients with PU and the relapsing lesions in the duodenum and in the overwhelming majority of the patients with gastric ulcer the disease developed at the background of chronic active gastroduodenitis associated with H.pylori. The success of the pharmacotherapy in the patients with PU was due to the use of the rational combinations of antibacterial and antisecretory agents.

[Several mechanisms of immunological adaptation in the etiology of subacute infectious endocarditis]. / O nekotorykh mekhanizmakh immunologicheskoi adaptatsii pri razvitii podostrogo infektsionnogo éndokardita.

The paper deals with the possibility of identifying the persons predisposed to the development of subacute septic endocarditis (SSE), with the prediction of the course of the disease and the clarification of reasons for the inefficiency of antibacterial therapy. The studies performed revealed the impairment of cooperative interaction of the immune system, which prevents it from fulfilling its main task, i.e. to make an immunological surveillance over the maintenance of internal constancy. Imperfection of this function in SSE patients and rheumatic heart diseases is based on the body's sharply limited adaptation which results from the genetically determined low values of the immune functional reserve realizable by the level of intracellular energy processes which are substantially lower in SSE patients, as evidenced by the studies conducted. This is very important for predicting whether it may develop in some patients with rheumatic diseases. The necessity of using large doses of antibiotics decreases the activity of intracellular processes to a greater extent, aggravating primarily phagocytic function, as reflected in the efficiency of antibiotic therapy.

[Evaluation of binaural interaction by the characteristics of short-latency auditory evoked potentials in guinea pigs]. / Otsenka binaural'nogo vzaimodeistviia po kharakteristikam korotkolatentnykh slukhovykh vyzvannykh potentsialov u morskikh svinok.

Binaural interaction was evaluated by determination of the curve of difference between the algebraic sum of brainstem evoked potentials which had been registered under monaural stimulation of right and left ear and potentials which had been registered under binaural stimulation. The curve of difference is characterized by three peaks: N1, P1, N2 with peak latency IV-IV' without any masking noise, and during masking with the signal-to-noise ratio of +20-0 dB additional peaks N0P0 are registered in III-III' latency regions on the difference curve. With an increase of the sound pressure level from 47 to 107 dB the P1N2 amplitude grows and relation of the P1N2 amplitude to wave amplitude IV of the sum of potentials registered during monaural right and left ear stimulation remains constant. Under masking conditions the above relation increases with worsening of the signal-to-noise ratio and the P1N2 amplitude decreases. Binaural interaction pattern is not supposed to alter with an increase in the click intensity level, and during masking with the signal-to-noise ratio of +20-0 dB specific features of neurophysiological mechanisms of binaural interaction are observed.

[Possibilities for pharmacological correction of regional osteoporosis in an unsupported extremity]. / Vozmozhnosti farmakologicheskoi korrektsii regionarnogo osteoporoza v bezopornoi konechnosti.

In 20- and 40-day rat studies the prophylactic effect of retabolil and calcitrin (calcitonin) against hypodynamics-induced osteoporosis was investigated. Hypodynamics was produced by surgical amputation of the lower third of the leg and hence by loss of the support function of the limb. Retabolil was injected intramuscularly at a dose of 0.2 ml once a day for 10 days and calcitrin was injected subcutaneously at a dose of 2 units MRC in 0.5 ml distilled water once a day. The results indicate that osteoporosis in the supportless bone of the experimental animals and that seen during space flight developed in a similar way. In the experiment retabolil and calcitrin inhibited the progressive development of osteoporosis but the strongest effect was obtained upon a combined application of the two drugs.

[Effect of thiamine on auditory evoked potentials of the guinea pig]. / Deistvie tiamina na slukhovye vyzvannye potentsialy u morskoi svinki.

Application of thiamine (1 X 10(-11)-1 X 10(-3) mol/l) on the membrane of cochlear round window increased the amplitude and decreased the latency of the auditory nerve action potential, waves I and II of brainstem auditory-evoked electrical potentials in response to acoustic clicks of different intensity. The mechanism of thiamine action on auditory-evoked electric potentials is discussed.