[Ascending aorta injury followed by cardiac tamponade after sternal puncture]. / Klinicheskoe nablyudenie punktsionnogo raneniya voskhodyashchei aorty s tamponadoi serdtsa kak oslozhneniya sternal'noi punktsii.

Heart or great outflow vessel injury followed by cardiac tamponade is an extremely rare event. However, it is the most dangerous complication of sternal puncture requiring urgent surgical intervention. The effectiveness of specialized care directly depends on its availability and timely diagnosis. Echocardiography is the simplest and informative method for objective diagnosis. We report successful surgical treatment of a 21-year-old patient with intrapericardial injury of the ascending aorta following sternal puncture.

[Hepatic leiomyosarcoma: a case report].

The authors present a review of pathogenesis, diagnosis and various approaches to treatment for an extremely rare tumor - primary hepatic leiomyosarcoma. This tumor is dif- ficult to be diagnosed by imaging examinations. The prevalent method of treatment is a radical resection (RO surgery). Ac- cording to literature the median survival of patients with LMSL is about one year with DFS after treatment about 10 months. Also the authors describe a case report of the successful cure of middle-aged female with primary hepatic leiomyosarcoma and Hodgkin's lymphoma in the anamnesis. She has undergone 6 cycles of neoadjuvant chemotherapy with Ifosfamide and Doxorubicin. The tumour response was estimated as partial. Then patient has undergone radical surgery in the volume of extended left hemihepatectomy with LND. Follow-up exami- nation 38 months after treatment revealed no progression of the disease.

[STENTING VERSUS PALLIATIVE SURGERY IN PATIENTS WITH MALIGNANT GASTROINTESTINAL STENOSIS].

AIM: Retrospective analysis of the results of stenting versus surgical palliation in patients with malignant gastrointestinal stenosis. MATERIAL AND METHODS: 85 patients underwent endoscopic stenting (41) or surgical intervention (44). Level of stenosis: gastric outlet (23/38), multi-level gastric obstruction (2/3), duodenum or jejunum (12/3), gastrojejunoanastomosis (3/0) and gastroduodenoanastomosis (1/0). 49 self-expanding metal stents were implanted in 41 patients. 41 gastroenteroanastomoses and 3 jejunostomas were performed in surgical group. RESULTS: Stents were successfully inserted in all patients. Early complications were observed in 3 (7.3%) patients after stenting and in 9 (20.5%) after surgical palliation, p = 0.0755. Postoperative lethality was 2,4% (1 patient) after stenting and 31.8% (14 patients) after surgery, p = 0.0003. Mean hospital stay was 15 days in stenting group and 23 days in surgical group, p < 0.001. There was no statistically significant difference in long-term results, neither in late complications (p = 0.3691), nor in survival (p =0.3697). CONCLUSION: Endoscopic placement of self-expanding stents is an effective method of restoration of oral intake in patients with malignant gastrointestinal obstruction. Stenting is associated with equal rates of early and late complications, lower mortality and decreased in-hospital stay as compared with surgery, and therefore may be recommended as a final palliation in inoperable patients.

[CURRENT STATE OF COMBINED TREATMENT FOR LOCALLY ADVANCED GASTRIC CANCER. ACHIEVEMENTS AND FAILURES: BASIC TRENDS IN CLINICAL ONCOLOGY].

Despite the modern achievements of different methods of treatment, primarily surgical, with recognized need of standardization of lymphadenectomy D2, gastric cancer still remains one of the most difficult malignant tumors characterized by high rates of one-year mortality and low rates of survival that are far from satisfactory. According to experts such unsatisfactory results are determined by a combination of factors: the characteristics of ill people, their functional status, age characteristics, the prevalence of the disease at diagnosis with the presence of systemic micrometastases, resistance to treatment, etc. Moreover, a factor of resistance to treatment i.e. to existing schemes and methods is mostly a key one that determines low levels of long-term survival.