Finding possible diagnostic markers for differentiating benign and malignant thyroid tumors on example investigate of rheological properties1.

BACKGROUND: The functioning of the thyroid gland is a multi-component process that in some conditions may undergo alterations. The thyroid gland is part of the endocrine system that produces the iodine-containing hormones thyroxine and triiodothyronine. Thyroid hormones, control metabolism and energy, growth processes, maturation of tissues and organs, regulation of blood flow, and, therefore, providing vital functions of the body. The role of thyroid hormones in the regulation of blood flow is determined by the intensity of their production and the quantity in the blood. Presumably, in case of oncological and non-oncological diseases of the thyroid gland, the fluidity of the blood, which depends on the rheological properties, will be different. OBJECTIVE: Our aim was investigating rheological characteristics for studying of changes of rheology in patients with thyrotoxicosis, with benign tumor pathology of the thyroid gland, with thyroid cancer and finding possible diagnostic markers for differentiating benign and malignant thyroid tumors. METHODS: In this regard, we examined, using modern methods accepted in clinical practice, a standard list of recommended diagnostic tests in the group of patients (thyrotoxicosis: n = 25; benign tumor: n = 47), thyroid cancer: n = 35) and control group (n = 15), and with new original methods, parameters that describe the rheological properties of the blood, such as blood rheological index, volume, thickness, surface area of erythrocytes, erythrocyte aggregation index, deformation index, plasma viscosity, hematocrits. RESULTS: Against the background of relative changes in the studied values, it is necessary to pay attention to the fact that erythrocyte aggregation in patients with a benign form and control, as well as in patients with a malignant form and control, differ significantly from each other, in addition, there is a significant difference between aggregation in the group of patients with benign and control aggregation. malignant forms of the disease. It is significant that aggregability differs in patients with thyrotoxicosis and in controls. This indicates that erythrocyte aggregation is particularly informative. The blood rheological index most clearly demonstrated the difference between benign and malignant forms of the disease. Significantly changed compared to control in various forms of thyroid diseases. CONCLUSION: Additional diagnostic markers for differentiating benign and malignant thyroid tumors may be consideredeerythrocyte aggregation index and blood rheological index.

CURRENT CONDITION AND CHALLENGES IN TREATMENT OF NON-HEALING WOUND AFTER RADIATION THERAPY (REVIEW).

Radiotherapy is a common cancer treatment, but often together with tumor cells, the surrounding normal tissues are damaged as well, which leads to the complications such as skin atrophy, soft tissue fibrosis, desquamation, epithelial ulceration which leads to poor healing of wounds. In this review, our main attention will be paid to the treatment of non-healing wound after radiation therapy. Irradiated wounds are often resistant to conventional treatment modalities and may often require surgical reconstructive intervention. The reconstructive options usually include skin grafts, local and regional flaps. Local flaps may be unreliable, since in some of the cases they are affected by irradiation. However, the complication rate with regional flaps is just as high as that with local flaps, and is not significantly different when analyzed according to the type of reconstructive procedure performed. In addition, such wounds affect not only the physical, but also the mental health of patients and their productivity. Therefore, non-healing wounds represent a significant problem for patients and remain a major challenge in modern medicine. Recently, for the healing of non-healing wound, several novel approaches have been proposed such as using the bone marrow stem cells (BMSC), biologically active dressings, bioengineered skin equivalents and others. Of special interest are bioactive membrane consisting of decellularized human amniotic membrane and BMSC paracrine factors, which may be effectively used for the treatment of non-healing wounds that have developed following the radiotherapy. Despite the positive results achieved in a number of cases, it is early to state that the all of the above methods is an ideal for the treatment of non-healing wounds, since it requires additional experimental and clinical studies for ascertaining positive and negative features.

[EVALUATION OF THE EFFICACY OF THE EXTENDED-COMBINED OPERATIONS ON THE ZONES OF PRE- AND PARATRACHEAL METASTASIS IN SUBGLOTTIC CANCER OF THE LARYNX].

After a retrospective study of the history of patients with a diagnosis of laryngeal cancer (2151 people), as well as the analysis of their own clinical materials, subglottic cancer was found in 103 patients, which was 4.8% of the total number of patients admitted to the hospital. One group of patients (n=39) underwent laryngectomy with subsequent irradiation, another group (n=64) was carried out by us developed and introduced into practice the method of the extended-combined laryngectomy. This method involves the mobilization and excision of the cervical tissue with lymph nodes located within it at the level VI level, the mobilization of the larynx and its removal at the level of the V-th or VI-th tracheal rings, as well as the dissection or thyroid share from the side of lesion in the unilateral localization, or complete dissection in the circular localization of the tumor. The comparative analysis was carried out on the frequency of metastasis in the pre- and paratracheal zones during the subglottic cancer of the larynx. A statistically significant (p<0.001) decrease in the incidence of metastases was observed in the advanced-combined laryngectomy (14.5%) compared with the traditional treatment (66.5%). If we consider that the main cause of death of patients with a tumor, both in subglottic cancer of the larynx and any other localization is metastasis, the development and introduction of new surgical methods that reduce the incidence of metastasis is a major breakthrough in practical oncology.

USE OF PERFUSION MRI FOR DETERMINATION OF IRRADIATION VOLUMES IN RADIOTHERAPY OF PATIENTS WITH BRAIN GLIOMA.

Objective - to assess how rCBV maps correlate with irradiation treatment plans in patients with recurrent tumor in order to identify potential differences and optimize treatment planning. 11 patients with brain HGG have taken participation in this study. Study was conducted in Radiation Medicine Center and Scientific Research Institute of Clinical Medicine. All patients underwent DSC-MRI and routine MRI imaging prior to re-irradiation treatment planning, and underwent treatment as per routine clinical protocol. After therapy, rCBV and radiation dose maps were overlaid on conventional MR to identify correlation between them. Of 11 patients in four cases, rCBV images showed a tumor outside the irradiation field. In the case of four patients, the tumor was completely irradiated, but with a large volume of healthy brain tissue. In the remaining three patients, the volume of irradiation and rCBV maps practically coincided. DSC-MR research has demonstrated better tumor identification in patients with high grade glioma compared to conventional MRI and can be used to improve radiotherapy treatment planning.

Functional state of red blood system as a possible predictor of individual radiosensitivity and carcinogenesis.

Functional state of the red blood system is being studied in patients with adenoma and carcinoma of thyroid gland. The aim of this study was to determine the possible predictors of the individual radiosensitivity and the probability of developing cancer on the basis of the comparable characteristic of functional state of the red blood system in patients with adenoma and carcinoma of thyroid gland. Functional state of the red blood system is being studied in patients with adenoma and carcinoma of thyroid gland. The functional state of RBC was determined by using the specially developed method based on analysis of the dynamics of peripheral blood erythrocytes distribution according to their spherulation degree (Q) and volume (V). Spherulation degree is considered as biological age and along with the volume determines the probability of their elimination from circulating bed. In connection with these positions distribution P=P(V,Q) express mechanism of production-aging-elimination of RBC of peripheral blood in circulating conditions and according to their dynamics we can discuss about the character of these processes. Revelation of differences certainly indicates high heterogeneity by the quality of young fractions of RBC of peripheral blood in patients with cancer versus the patients with adenoma. This parameter may be determined as a marker of individual radiosensitivity and probability of developing cancer. However the issue about haemopoesis instability in patients with cancer, whether it is caused by genotype, phenotype or toxic action of products of disintegration of tumors, demands the further researches.

Correction of diabetes mellitus by transplanting minimal mass of syngeneic islets into vascularized small intestinal segment.

Transplantation of mature islets into portal vein has been most effective thus far, although attrition of transplanted islets constitutes a major limitation, and alternative approaches are required. We analyzed the mechanisms by which islets engrafted, vascularized and functioned over the long term in the small intestinal submucosa. To determine engraftment, survival and function, 350 syngenic islets were transplanted into either intestinal segments or portal vein of diabetic rats. Islet reorganization, vascularization and function were analyzed by histological analysis, RT-PCR analysis as well as glycemic control over up to 1 year. Transplantation of syngeneic islets in marginal numbers successfully restored normoglycemia in diabetic rats. Transplantation of semi-pure islet preparation did not impair their engraftment, vascularization and function. Islets were morphologically intact and expressed insulin as well as glucagon over the year. Expression of angiogenic genes permitted revascularization of transplanted islets. We identified the expression of transcription factors required for maintenance of beta cells. These studies demonstrated that marginal mass of transplanted islets was sufficient to restore euglycemia in streptozotocin-treated rats. These superior results were obtained despite use of an impure preparation of islets in animals with small intestinal segment. Our findings will help advance new horizons for cell therapy in patients with diabetes.

Combined development of thyroid gland and reproductive system benign diseases.

The aim of the study is to establish the role of endocrine disturbances in development of malignant tumors in patients with thyroid gland and reproductive system pathology. We studied 207 patients with synchronic and metachronic development of thyroid gland and reproductive system benign tumors. The patients' average age was 35-58 years. According to study the following aspects were determined: clinical and hormonal aspect of thyroid gland and reproductive system benign tumor disease coincidence, analyses of thyroid gland and reproductive system pre-cancer disease pathogenesis, neuroendocrine relations-like increased thyrotrophic hormone secretion causes strengthening of prolactin secretion, which depresses luteinizing hormone release and increases production of follicular stimulating hormone. It has been proved that fibromyomas absolute hyperestrogenemia which develops during hypersecretion of follicular stimulating hormone (FSH) plays a role in etiology of uterine Gonadoliberin hypersecretion, especially follicular stimulating hormone FSH and corpus luteum deficiency is very important in development of ovarian pre-cancer and cancer diseases.

Novelties in treatment approach of poly-neoplasias developed during thyroid pathologies.

In publication were discussed pathogenic mechanisms which are developed during concordance of malignant tumors of thyroid gland and reproductive systems and dishormonal hyperplasias, also functional disturbances which accompany thyroid gland diseases and principles of treatment during synchronic and metachronic manifestations. The treatment of polyneoplasias by "neurotransmitive control" is proposed. Importance of thyroid suppressive therapy was assessed. The efficacy of thyrotrophic hormone suppression by neurotransmitters in prevention of malignant tumors of reproductive system was reported.

Peculiarities of synchronic and metachronous malignant tumors of reproductive system in thyroid gland cancer.

The aim of our study was to establish a reliable method for the evaluation of mechanisms of tumor development and early diagnostics of tumors of the breast and female genital organs in patients with thyroid gland cancer. For this purpose 29 female patients with thyroid gland cancer and different accompanied diseases of reproductive tract system have been studied for six months. During this period patients' clinical, hormonal and ultrasonographyc indicators were analyzed. The study showed that, suppressive therapy is preventive method in development of pre-cancer diseases of reproductive system. Thyrotrophic hormone hypersecretion (long current latent hypothyroidism) conditions thyroid gland proliferative activity; high level of gonadoliberin provides proliferative activity of organs of reproductive system.

About mechanisms of multiple cancer development.

The article discusses the possible pathogenic mechanisms of breast and thyroid malignancy as simultaneously developed diseases. The goal of this article was to reveal the frequency of breast cancer among patients with thyroid malignancy; to study the role of thyroid disorders in development of breast cancer; to determine the effectiveness of conservative medical management of thyroid gland after radical surgical treatment of thyroid cancer in prevention of breast cancer. Interaction of breast and thyroid malignancy was studied. As the first stage of scientific investigation the frequency of breast cancer among the patients having thyroid gland malignancy was analyzed; the role of disorders occurred during it in triggering breast cancer was identified; the effectiveness of medical management after radical surgical treatment of thyroid malignancy in preventing breast cancer was determined. Specific hormonal indices and markers of breast cancer among the patients having thyroid gland malignancy were determined. Ultrasound and cytological examinations were performed. The possibilities of prevention breast or thyroid malignancy development were studied. Algorithm of diagnosis and treatment of breast cancer in patients with thyroid malignancy were created through systematization of interconnections between both pathologies.

Suppressive therapy after surgical treatment of thyroid gland cancer in patients with mastopathy.

State of lactation system during oncological disorders of thyroid gland is one of the poorly studied topics of modern medicine. Controversy in clinical and experimental data creates the need of performing studies in this direction. The goal of this study is to investigate determining pathogenic mechanisms of thyroid and lactation systems. Realization of the study results will enable development of guidelines for prophylaxis, diagnosis and treatment of mammary gland cancer in patients with thyroid gland malignancy. For this purpose we investigated patients with different types of malignant cancer of thyroid gland (after surgery), who had diffuse fibrocystic mastopathy as a concomitant disorder. Patients underwent conservative therapy only with thyroid agents. We observed patients for 6 months since the beginning of the treatment. During this period patients' condition was evaluated several times using examinations involved in the study. Summarization of study results demonstrated that suppressive therapy might prevent precancerous diseases of mammary gland.

[The local and general complications after the lower lip cancer treatment].

The aim of our research was to analyze general and local complications during the restoration-reconstruction operations in patients with epidermoid cancer on a lower lip. We have analyzed 61 patients' histories who were treated at the department of head and neck tumors of A. Gvamichava National Center of Oncology during 1990-2000. Based on the spread of the disease at the certain stage of treatment surgical operation becomes necessary that is broad excision of the tumor. Unfortunately it is impossible to restore the lip with the help of the local tissues that demands to perform restoration-reconstruction surgery with the use of rotated or free skin-muscular or mucilaginous-muscular scraps and consequently we considered it expedient to estimate functional and cosmetic efficiency of the used restoration-reconstruction surgery. The most attention was paid to analyze the local and general complication that might significantly influence cosmetic and functional results of the treatment. Based on our investigations it may be concluded that after the surgical treatment of the cancer of the lower lip the local complications is detected in 23,1%, among which the most frequent is secondary wound repair along with formation of oral fistula. After the performed restoration-reconstruction surgery the scrap necrosis was detected in 5 cases (8, 2%). The mentioned complication mostly was developed in patients for whom the rotated scrap was taken from upper lipt.

Establishing of the first private autologous cord blood bank in Georgia at the German-Georgian Specialized Oncological Clinic.

German-Georgian Specialized Oncological Clinic is a private clinic located in Tbilisi, Georgia. Close collaboration with German clinics and research laboratories has enabled the clinic to study cord blood hematopoietic stem cells. These studies created a scientific basis for establishing a cord blood bank. A municipal grant from the city of Tbilisi allowed the clinic to establish a program for the support of families with oncohematological patients. The program collected and stored cord blood for families with oncohematological histories. This grant has also enabled the establishment of an autologous cord blood bank and created opportunity for cord blood banking in Georgia. Work on a national legal basis of cord blood banking together with the Ministry of Labor, Health and Social Affairs of Georgia is another important activity of the German-Georgian Oncological Clinic.

[About correlation of dysfunction of the thyroid gland with fibrocystic diseases in women].

The reference data contain a lot of information on the interrelation between destroying of a thyroid gland and fibrocystic diseases. However contradictions in these data proves that this issue is not solved completely. The aim of the given study was the investigation of interrelations between frequency of occurrence of pathology of a functional condition of the thyroid gland and the frequency of occurrence of fibrocystic diseases. 90 women aged 23-50 were investigated. Concentration of thyroxin (FT4), thyrotrophic hormone (TSH), titers of antibodies to thyreoperoxidase, microsomal fraction of thyreocytes and thyreoglobulin were measured by ELISA. Palpation and ultrasonic investigations of thyroid and mammary glands were used, morphology of central formations of mammary glands according to indications was also carried out. A special questionnaire was completed for each patient. Our investigations showed that along with the declining of function of thyroid gland and the increased level of TSH in the blood, the risk of development of fibrocystic diseases is increased twice.

[Evaluation of effectiveness of radiation therapy for regional control in supraglottic larynx cancer].

The supraglottic cancer is characterised by high incidence of regional metastasis significantly worsening the prognosis. Working out of an adequate regional control represents the one of the important problems. The aim of the study was the evaluation of pre-operative radiation therapy in 331 patients with N-negative supraglottic cancer. Three groups of patients were analyzed: I-radiation therapy/laryngectomy, II-laryngectomy/radiation therapy, III-only laryngectomy. It was found that the main prognostic factors of regional metastasis are: extension, differentiation, ulceration and growth pattern of tumor. The pre-operative radiation therapy is reasonable for effective regional control. The fact that the regional recurrence is developing faster in patients not conducted the radiation therapy at all is also indicating on the above-mentioned. Despite the fact, that the regional control is improving with pre-operative radiation, the overall survival of supraglottic cancer could not be regarded adequate, which requires the further study in terms of evaluation of preventive neck dissections with laryngectomy is this group of patients.

[Features of regional spread of supraglottic larynx cancer].

Development of adequate methods for surgical regional control in supraglottic cancer is one of the most important issues in the management of this disease. The retrospective analysis of 863 patients with supraglottic cancer was conducted. The main clinical and pathological factors influencing the metastatic process were studied. According to the study results the supraglottic cancer most frequently had metastasis in the group I-III lymph nodes. The frequency of regional involvement was high in the period of 6 months after the tumor occurrence and especially increased after 12 months, which indicates to tumor aggressiveness. The possibility of regional metastases increases with the raising of T criteria. The endophytic and mixed growth pattern tumors had metastases with higher frequency compared to egsophytic tumors. The tumor ulceration and low differentiation correlated with high frequency of regional metastases.

[Methods of preventive treatment of the regional metastases in patients with squamous cell carcinoma of the oral cavity].

The aim of the study was to evaluate the efficiency of different methods of preventive treatment considering the incidence of regional metastases and survival rate in squamous cell carcinoma of oral cavity. 139 patients were evaluated who were treated at the National Center of Oncology during 1985-2002. According to study results, the following was concluded: the preventive treatment is reasonable in mentioned tumors for regional control, which allows decrease of regional metastases incidence and improves the 2-year survival rates; the surgical method is most preferable among the preventive methods of treatment. Using this method, the metastases were found in clinically negative neck in 37,5%, it decreases the incidence of metastases to 21,9% and raises the 2-year survival rate to 69,0%.

[Plastic surgery of the cervical segment of the esophagus using free autologous transplant of a fragment of the small intestine]. / Plastika sheinogo otdela pishchevoda svobodnym autotransplantatom otrezka tonkoi kishki.

The article presents an experience with the treatment of patients with malignancy of the larynx, laryngopharynx and cervical part of the esophagus with a free autotransplant of the small intestine using a microsurgical technique for reestablishment of the arterial and venous blood circulation in the transplant. On the basis of the postmortem material the advantage of using the initial part of the jejunum were revealed. Experimental studies for the development of the microsurgery technique allowed the authors to propose some methodical means specially for the above operations. Eight operations were performed in the clinic with good functional results.

[Plastic repair of the cervical esophagus using a small intestine autograft in patients with malignant tumors of the larynx and laryngopharynx]. / Plastika sheinogo otdela pishchevoda tonkokishechnym autotransplantatom u bol'nykh so zlokachestvennymi opukholiami gortani i gortanoglotki.

A one-stage procedure to restore the cervical part of the esophagus and laryngopharynx included extended surgery for advanced cancer of the larynx and laryngopharynx and grafting a free revascularized small intestine segment using microvascular technique. Free small intestine transplant proved well-fed by sufficiently large branches of the external carotid artery, and normal venous drainage was retained. The transplant proved biologically best suitable for such type of plastic surgery. Treatment results should be considered promising.